Why is my pupil dilated and unequal following retina Laser procedure?

[Jes2000]

4 weeks ago I was diagnosed with lattice degeneration. The lattice in my left eye was worse and I was seeing dark floaters indoors and outdoors, and the retina specialist said the fluid was pulling up on my retina and he recommended the laser repair. I decided not to treat the right eye unless it becomes symptomatic like the left eye did.

It's been 3 weeks since the procedure and my pupil is still slightly dilated than the other one. It reacts to light (doesn't get as small as the right eye) but it is slow to dilate at the same pace as the other one in darker lighting. My vision is a little blurry close up now.

I went back after 1 week and he said my pupil was staying dilated because I had some inflammation so he put me on prednisolone 1%

I went back in with a scare because I was having a flashing light in my upper right corner of my treated eye (near my nose) and the on call doctor met with me. I noticed while my eyes were being dilated the left eye had a weird shape (more space was at the bottom of my iris while it was dilating.) but it eventually did get round and dilate to the normal round shape, fully. It took a longer time to dilate than the right eye, but it did get there eventually.

The on call doctor said the jelly was attached entirely around the retina and that the retina where I was treated looks exactly as it should. He didn't give much of an explanation for the flash. It only happens 4-6 times a day when I move from light rooms to dark rooms. Could my retina be reacting differently to certain lighting now? (The laser was done in the bottom of my eye.)

He also said the inflammation in my eye has gone down. I asked why my pupil is still slightly dilated if the inflammation has subsided and he said "I will have to ask the retina specialist."

I don't want to call again because that is as my 3rd "emergency" visit and I feel like I've been going crazy. I want to try and wait for my (hopefully) final follow up.

My questions are-

Since my pupil is reacting to light does that mean it could go back to the same size? (I'm nearsided and have light eyes, I was not given the stronger dilation drops.)

Could the steroid drops be causing my pupil to stay where it's at? (I'm tapering off the drops the next few days)

Is my retina reacting to light differently? Should I worry about the flashes or is this a normal side affect?

Should I be worried about the shape of my pupil mid dilation?

[JohnHaganMD]

1.  Some pupils remain permanently more dilated (to varying degrees) after laser surgery and even more common retinal detachment surgery. Time will tell. Most return to normal.
2. Steroids would not cause the pupil to be dilates
3. No your complaint of flashes occasionally post treatment is common usually 180 degrees from where the laser was done. you can use the search feature and archives and read about people with similar complaints
4  No not as long as it eventually dilates round. More drops get on the lower part of the eye so the inferior pupil generally dilates faster.

[Jes2000]

Thank you so much for your quick and informative response.

Do you ever notice a specific timeframe when the pupil returns to normal?

When pupils do not return to normal- are they generally dilated much more than the other eye? I'm sure every case is different but this is a new world for me.

Thanks again.  

[Jes2000]

.

[JohnHaganMD]

Its not possible to generalize. The difference is usually small and not cosmetically or functionally noticeable.

[Jes2000]

Thank you. I'm myopic and I can't see with my normal prescription up close. The pupil is about one more size than the other on average, and it looks like it's positioned lower and a little more oval than round on some days.

Could there be nerve damage? I'm so confused by all of this because I have gotten so many different answers by different people.

How does this happen and how does the eye rejuvenate itself if it can? My doctor told me I wasn't at risk for side effects because of the position. (Bottom of the eye.)

[Jes2000]

Thank you. I'm myopic and I can't see with my normal prescription up close. The pupil is about one more size than the other on average, and it looks like it's positioned lower and a little more oval than round on some days.

Could there be nerve damage? I'm so confused by all of this because I have gotten so many different answers by different people.

How does this happen and how does the eye rejuvenate itself if it can? My doctor told me I wasn't at risk for side effects because of the position. (Bottom of the eye.)

[JohnHaganMD]

When the pupil is larger than it should be it makes it harder to focus up close. Normally this is not a problem unless you are in your early to mid 40's.

I told you this is not a rare problem. There are other people posting the same problem.  The laser is applied to the retina to create a burn that forms scar tissue that holds the holes/tears shut. The nerves to the pupil travel under this layer.  If the tear is over the nerve and the nerve is very close to the surface the nerve can be damaged.  Like any healing process it will make an effort to repair itself. This is all I will have to say about your situation.  No operation is free of complications or side effects and you undoubtedly signed a consent
for surgery that listed them.  As I said I will not be commenting more as you seem confused by talking to so many people.

[Jes2000]

Thank you very much for your time. All the best to you.

[JohnHaganMD]

Yes good luck to you also