That is not standard treatment and the peak risk of rebleed is 3 to 5 days after the initial injury. The re-bleed can be even larger than the original injury. I doubt very many ophthalmologists would turn you out unfettered to play again this soon especially since your vision is still blurry.
Suggest you get a second opinion. Never play a ball or racquet sport again without full athletic eye protection.
JCH MD
Yah, he mentioned not to do any sports till Saturday at the least, and then I repeated the question asking if I could indeed play on Saturday and he said it would be ok.
Saturday would make 10 days after the injury.
Maybe I'll have someone else look at it in 2 days. Get another opinion. I don't want to push my luck if its indeed not good.
Okay but be sure you don't get a second hyphema, or retinal detachment. Wear eye protection.
JCHMD
Absolutely John, I think for low level gym stuff I'll wear some glasses now, and at higher levels at the rink I already wore a helmet with a shield. I'll have to use a cage for the short term to insure total protection.
So its been 34 hours since I took my first drop of 1% Cyclogyl (was suppose to do this for 2 more nights), and the eye hasn't yet fully gone back to normal.
It has SLooooooowly been returning. It's maybe 50%, but still won't close fully to re-act with light (it is reacting to dark and opening). I called the pharmacist last night who told me to discontinue with the drop if hadn't returned to normal by this morning.
Using this stuff already scared me. At least my vision continues to improve daily. The Hazing effect from being still to moving feels less. Still have some light halo's and sensitivity to light, but not in a painful way. I feel like this is due to the Pupil situation though.
Whats the point of dilating the eye if it was moving well beforehand? is it to keep the clots from breaking? promote the blood absorption ?
Called my specialist this morning, and they said I could discontinue the use of it as well.
They are now blaming the pupil on traumatic iritis, but considering it was working fairly well (not 100% I know), but better than this before I used the drop. When I mentioned that they said that it should return. Grrr.... guess all I can do it wait now and see if there is improvement.
2:00 now. Scheduled an appt with my local optometrist for Thursday. Someone I trust. Get a 2nd opinion, and another look :)
The fog that picks up if I start doing to much is still the most frustrating part outside of the light issues, and up close focus. I am hoping despite most of the blood being visually gone that its just that, and it'll go away.
No re-bleed issues, day 5 now, yay.
Your treatment was really less that what's usually done. For a number of years I gave a lecture at a local medical school on treatment of hyphema. Usually a very strong dilation drop (atropine or homatropine) is used to completely dilate the eye and keep it dilated for 7 days and it usually takes another 7 to completely wear off.
Because of the hyphema your eye is at higher risk for traumatic retinal detachment, traumatic cataract and traumatic glaucoma.
At some point in the next couple of months your pupil need to be widely dilated and the peripheral retina checked to be sure no holes, tears, retinal detachments or a type of tear at the retina periphery called a dialysis. Also you need a test called gonioscopy to see if the drainage angle of the eye was damaged (angle recession). If it has been torn the risk of glaucoma down the road about be 5-10%. You also need a baseline glaucoma set of tests: visual fields, optic nerve OCT, cornea pachymetry to be used to see if any further changes down the road.
Lastly hyphema's are sometimes associated with tramatic iridoplegia where the pupil remains larger than the uninjured eye and does not react like before the injury.
I would strongly suggest you read this article carefully on the treatment and follow up of hyphema: http://www.emedicinehealth.com/hyphema_bleeding_in_eye/article_em.htm#hyphema_bleeding_in_eye_overview
Thanks for the info :)
I've been doing a lot of reading on the subject trying to understand, but wasn't sure what to expect on the followup down the line so this is good to know.
I'm going in on Thursday to have it looked at again by an optometrist I trust. Then again to have it looked at Mid-april (about 5 months) a little sooner than the 6 months I was recommended by ophthalmologist.
May I ask, what is the purpose of dilation is? It seems common practice to look at the eye, but for the injury is it to help the inflammation?, reduce the chance of re-bleed?, help with re-absorption?
The second question is, the issue with my eye fogging over. I'm at the point now where if I sit for 15 minutes or so my vision is very good, outside of near sided focus and light issues. However, if I move around esp looking down at things, it fogs up. Is this still from the blood getting kicked up? should I be concerned over this or is this something that just needs time?
Dilation: Think about how broken bones are cast and injured joints are splinted. The dilation "rests and immobilizes" the iris, reduces the chance of rebleed, helps with prevention or treatment of traumatic iritis and reduces inflammation, also helps prevent the iris from scarring to the lens and getting scarred shut (synechae).
The blur at near could be due to the injury, the pupil not working normally and/or some blood still in the anterior chamber.
The optom will need to sort through the possible causes.
JCH MD
synechae, that looks horrible :)
Thanks for the info Doctor. Hopefully this will help other readers as well. Things that aren't well explained elsewhere !!! This board and forum has been the most helpful thing on the net. Thank you.
Day 5 at night, able to finally drive today, felt a little off during the day, but not bad at all. Sunglasses do help calm the effect down. Also drove at night time is much easier outside of all the halo's on every light.
Day 6 now, and the Pupil looks like where it was before the drop. Still larger, but not as notable. Not sure if this is from the Cyclogyl finally out of the system or because its healing very slightly from the last two days. looks like a 1mm - 1.5mm difference at this point in more aggressive light.
Clarity this morning seems again slightly improved compared to other mornings. The last few mornings I would wake to more a haze that would settle after a couple hours to the sort of vision I'm experiencing this morning already. Not sure how it'll be if I start to look down and move around yet. Other than Dry eyes at night, feels good. Despite the Doc telling me I didn't need to sleep elevated all the info online suggests the opposite so I've continued to do that, but unsure of when to stop.
10am, The sun came out, and I can handle it inside or outside even coming off the snow. Light Sensitivity way down I'd say. Thinking this is due to my pupil being a bit smaller today? Either way, yay!
Now 11 at night (Wed) , so vision improvement for sure, but a couple new things.
Experiencing dry eye or eyelid? feels more like the eyelid part .... all day. Really bizarre feeling. pharmacist said it is a side effect prednisolone. So I picked up some eye drops to help. Also having a little pressure down the bridge of my nose just this evening.
Second, I think I'm also experiencing flashes in the bad eye, very bottom, light a quick flash from left to right. Very infrequently, and only very late at night. Maybe 2-3 times last night, and 3-4 tonight so far. ophthalmologist commented 5 days ago that the Retina looked good and there was no tears inside. Will mention it to the optometrist tomorrow morning when I'm there. Curious...
If flashes or new floaters occur anytime in the future the eye needs to be checked with dilation. The fact there were no retina tears does not mean that ones or a retinal detachment could not develop down the road. JCH MD
So optometrist visit was very positive.
Said everything looks much better than he expected from the report he had, and that it all looked very good. Had some concerns over the pressure of out the eye (now 31 from being under 20), but said it was likely the Pred, and wants to dial me off it quicker, and retest the pressure next week to see what it looks like.
Also said I'd be good to play this weekend as well.
At what point does a person need to go back to get their prescription rechecked? I know its to soon yet at 11 days post. Not sure what kind of time frame is needed for this kind of injury.
No problems after this weekend, no more halo's at night, no sun sensitivity, and no issues with hazing over anymore. Pupil is still a little off from the other but I've adjusted to it I think. Just blurry at a distance now.
This type of injury should not change your glasses RX. If your distance vision is blurred I would see one of the doctors following your eye injury
JCH MD
ok, thanks. I can't tell if its because of the Pred, but yah something is still off. I did a printable acuity eye test, and I still see 20/20 from both, but looking around things are blurry at distance. I can't really make sense of it. Going to see the optometrist again Thursday.
Off the Pred today (yay, really tired of dry eye/eyelids)
So different question all together. What is the percentage chance of cataracts with this type of injury? Does that percentage change with the degree of trauma?
If Traumatic cataracts do present themselves how fast do they develop or can that vary as well?
Lastly, out of curiosity. I read that steroids can trigger or bring the onset of cataracts why is this then given for injuries ? and is there no other way to control inflammation? or is the other kind of steroid that they are referring too?
Thanks in advance.
This type of injury does not lend itself to generalizations or standardized testing because each of these injuries are unique. So no figure can be given for traumatic cataracts/glaucoma/retinal detachment.
The side effects of steroids causing cataracts comes from long term use say greater than 6 months. Its the same way with oral steroids. Steroid dose packs are used for things like poison ivy for a week or so without little risk. On the other hand anyone on oral or eye drop steroids for a year will likely have some side effects.
JCH MD