post op pupil dilation after split thickness corneal transplant

[CAT1213]

I had a split thickness cornea transplant in February.  My pupil is "paralyzed" and is not constricting to light.  I am having a difficult time with bright light or changes in light intensity (going back indoors after being in the sunlight).  My physician's office "forgot" to give me my steroid and antibiotic eyedrops on my 1 day post op check up.  These drops were supposed to be put in my eye every 2 hours.  My post op pain and irritation was near unbearable for the first week until my physician realized I wasn't putting any drops in my eye.  Also, I received no post operative instructions (such as preventing water from entering my eye) and I didn't follow any of these instructions until 1 week - when I received them from my physician.  Could this be a reason why this scar tissue developed preventing my pupil from constricting?  Thanks for your help.

[Christopher C Shen, MD]

A frozen pupil could be caused by a variety of causes.  It could be dilated from the surgery if there was a lot of manipulation of the iris involved although this would be unlikely if the surgery was strictly limited to the cornea (was cataract extraction also involved?).  Typically a non-reactive pupil related to scar tissue tends to be constricted as opposed to being dilated so treatment would be to decrease any inflammation with the eye and use a very strong dilating drop to break the scar tissue.  Delay of administering the drops by one week would be unlikely to create any scarring based on my experience.

[CAT1213]

Thanks for your information.  I did have lens replacement done since I am only 53 and had a small cataract forming.  I feel better knowing that the lack of post op care was a cause of this.