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Avatar universal

Pupil size

I had surgery for a detached retina 2 months ago.  I had the fluid drained, gas bubble  put in and the buckle around the eye.  I had a very large tear in my retina and this had to be repaired with a laser.  I now have a cataract which I am going to have surgery on next week.  The cataract will be removed and replaced with a lens.  The issue is my pupil that had the retina surgery will not contract down as small as the other eye.  I have uneual pupils now.  The question is why did this happen?  the doctor says it could be the laser and he doesn't know if it ever be the same as my other eye.  Does anyone have the answer?
22 Responses
Avatar universal
MEDICAL PROFESSIONAL
Pupil abnormalities, especially a pupil larger than the other side and sometimes a large pupil that does not constrict at all, can occur as a complication with most types of surgery within the eye. The reason for this is that the nerves that go to the pupil run within the layers of the eye going from the back to the front. In retinal detachment surgery any number of things from laser, manipulating the eye muscles, applying freezing (cryotherapy), draining the fluid under the retina can cause damage to the pupil. In other types of surgery such as cataract and corneal surgery the problem usually occurs due to direct trauma to the iris. Another common cause is increased pressure pre- or  post-operatively within the eye can damage the pupil nerves.  These problems connot be avoided in most cases because the nerves to the pupil cannot be seen from look in the eye or looking on the outside of the eyeball and or to repair the problem in the eye requires laser/freezing right over the nerve.

It is possible you might see some improvement but 2 months is a long time and it is possible it will never be the same size or work as well as the other non-operated on eye. The pupil should not cause any problem with cataract surgery or insertion of an implant.

In terms of what you do about this your options are limited. If sensitive to light sunglasses, photochromic lens (Transitions, Photogray, etc) and a hat can help outside, even sun goggles. There are drops to constrict the pupil but they can have side effects especially in a person with retinal detachment and the pupil would always be small and not move naturally. People with a "blown pupil" so dilated the iris/pupil almost looks completely black and who are disabled by the glare and photophobia may elect to have a purse-string stitch put in the iris opening to pull it down to a smaller size. Again the pupil doesn't move, it's always the same size and this can make checking your retina difficult.

An occassional patient with this problem has found tinted contact lens helpful.

JCH MD Eye Physician & Surgeon    (Ophthalmologist = Eye MD)

Avatar universal
t sounds like I am going to have unequal pupils permananetly
My eye is still slightly red, definite;y not as white as my right eye.  Will that imprIve with time?  Also I can see the scars in the white of my eye and I am wondering if that will eventually go away?   When I had the operation I asked my doctor if the eye would eventually look the same as the right eye, he said yes.  Now I am finding out that this will not happen.  I am lucky I can see.  I hope the cataract operation goes well.  I look forward to your response.
Avatar universal
It sounds like I am going to have unequal pupils permananetly
My eye is still slightly red, definite;y not as white as my right eye.  Will that imprIve with time?  Also I can see the scars in the white of my eye and I am wondering if that will eventually go away?   When I had the operation I asked my doctor if the eye would eventually look the same as the right eye, he said yes.  Now I am finding out that this will not happen.  I am lucky I can see.  I hope the cataract operation goes well.  I look forward to your response.
Avatar universal
MEDICAL PROFESSIONAL
The retinal detachment operation is a BIG operation on very vascular tissue and persisting redness is a frequent complaint (including in this forum). The eye should continue to whiten for up to 3-4 more months. If you look carefully especially looking to the side you may be able to the encircling element (the 'buckle") around the eye, you may be able to see the stitches used to anchor the buckle and the stitches used to close the sclera where the instruments were placed in your eye for the vitrectomy. This "hardware" is permanent and if that's what you're seeing it will be there "for good".

Please reallize that you are much more aware and conscious of these than the people you come in contact with. I hope you cataract surgery goes well also. It's much less of a stress on the eye that your pervious procedures.

JCH MD  Fellow American College of Surgeons
Avatar universal
Thank you for the information.  I cannot see the buckle.  What I do see , are the scars on the white part of my eye near the inner corner towards my nose.  The whitre part looks lumpy.  Will it stay that way?  Or will it smooth out? I appreciate all the answers you have given me.  
Avatar universal
MEDICAL PROFESSIONAL
This is a generalization but it usually improves with time but on close inspection the lumpy areas can still be identified. Ask your retina surgeon about this next visit.

JCH MD
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