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One Pupil Dilated

I went to a Sleep Center yesterday for a sleep disorder, and the Dr. examining me noticed that my left pupil was dilated about twice the size of the right one.

He asked if anyone had told me that-and they haven't.  I have never noticed that to happen ever before in my life.

I asked what it meant, and he was rather dismissive and didn't seem to take it too seriously.  But he was interested enough to make his two residents look at my pupils.  (This was a University affiliated Medical Center, a teaching hospital).

He did tell me that if it was sudden onset, it could be something dangerous like a brain bleed or a stroke.  He rather offhandedly suggested I might want to tell my Dr. and have an MRI done.  But again, didn't seem overly concerned.

So naturally this scared me and I did research online.  Almost every case with my symptoms seems to indicate a ruptured Aneuryism or stroke.  But, some research did say it could be due to stress and sleep deprivation, both of which I had a great deal the last few days due to anxiety about this appointment.  But I noticed I was having a lot more physical anxiety than usual the night before and day of this appt. yesterday, and a great deal of confusion and trouble processing information.  I felt horrible.  My mind was very confused and perceptions distorted, as in physical anxiety being acute.

I am guessing it's probably more due to stress and sleep deprivation.  I tried a Lunesta the night before, and it only gave me 3 hours of sleep before causing so much anxiousness I couldn't sleep the rest of the night.  I later found out a great deal of the physical anxiety/confusion I have been experiencing is likely due to side effects from the Lunesta, as a lot of people have the same problems and it was noticeable compared to normal.

Should I be worried about the dilated pupil?  It's still there.  I am also having a really bad headache, but feels more like sinus but it's painful.  I am very dizzy, and eyes are extremely light sensitive all of a sudden.  I can't tell how much of this is stress/sleep deprivation and/or side effects from the Lunesta, which can cause similar symptoms.  My father currently has a bad head cold, and I figured I was catching it as some sort of URI or sinus thing.

Any ideas?  I did try calling my main Dr. to ask his opinion about the pupil, and whether I should check it out with a Neurologist but he never called me back yesterday.  I am leery about spending a lot of money on a Neurologist and  MRI without health insurance (2 to 3 grand maybe?) if it's not really necessary.  But the pupil is lasting a long time, since it was diagnosed this morning so I am wondering.  Also-the research said sometimes higher doses of antihistamine could cause one dilated pupil, and I did take two doses of Benedryl to sleep that night.  But it's never done this before and it wore off hours ago.

What should I do?  Just watch and see what happens?  If it were something as serious as a stroke or brain bleed, wouldn't I know by now?

Thanks for any help.
63 Responses
700950 tn?1228611035
I work in ophthalmology. Don't take this lightly. This can be very serious. Why do you think they always check your pupils after an accident or in an emergency. It is a good indicator of brain involvement. If your pupil is blown (meanng it is large and doesn't constrict and become smaller in brighter light conditions) this could be urgent. If I were you I would show up TODAY at a ophthalmology clinic and demand to be seen. Do not see an optometrist. It needs to be an ophthalmologist. An ophthalmologist can rule out causes and refer you for care. The other choice would be to go directly to an neurologist. If you can't find someone, I would go to a hospital ER, not an urgent care clinic, but a hospital ER. They will be trained to be suspicious of a blown pupil.

Don't take this lightly. It may be that your doctor didn't believe what he was seeing. Let me know what you find out.
Avatar universal
Thank you for your help.

Not sure the pupil is 'blown'.  It's roughly twice the size of the right one.  It does constrict immediately with light, but then adjusts back to twice the size after a moment.  When I was looking at it in the mirror during daylight, I had to cover that eye to get it to go back to the larger size because light was making it constrict.  It is still quite round, not oblong.

I am thinking it might be related to serious sleep deprivation and stress, as I had a terrible night the night before and only got about 3 hours of sleep.  Plus the Lunesta caused severe side effects including anxiety and confusion.  So that was affecting me physically.  I also took a double dose of Benedryl that night, (a few hours apart) and that can apparently cause this as well.

I am also wondering if it were something as serious as a brain bleed or stroke, wouldn't I have known by now?  I sure hope it isn't something just waiting to happen!

Thanks again-will keep an eye on it.  Not particularly fond of my Eye Doctor, but if I have to go see him I can.  Not sure he could tell me if it's neurological or not tho.
Avatar universal
An update:

I am taking Scooter's advice and going to see my Eye Doctor this morning.

Although I am pretty sure the dilated pupil isn't anything serious, it's been causing anxiety due to worrying about it.

So I decided to check it out the easiest way and go to my Eye Doctor, who could fit me in quickly and doesn't cost much.

Will update again if I find out anything.
Avatar universal
Another update:

My Eye Doctor was great, did a thorough exam (for this issue), even including a glaucoma repeat test.  Looked inside eyes thoroughly.  Even got out some old medical reference books to look it up--but couldn't really find anything wrong.

Since I have a head cold/possible sinus infection, we decided a lot of the symptoms I am having are probably due to the sinus thing.  Dizziness, sinus-type headache, light sensitivity, etc.  He thinks the dilated pupil is most likely associated with the sinus infection as well.  Which does make sense to me, as my left sinus area is more affected than the right sinus area in terms of symptoms.

So he checked everything thoroughly, still perplexed but came to the conclusion that most likely it was just a sinus issue.  He also checked my back charts, and found that in 1996 he had reported my left pupil being slightly bigger than my right pupil.  So I have had this before, just not as dramatic.  Currently my left pupil is about 2/3 mm bigger than the right.  So that was comforting; as it could just be physiological for me triggered by the sinus problems, stress and sleep deprivation.

He also gave me the name of a really good Neuro-Ophthamologist, if I still have the dilated pupil in a week.  He said I should check with either a Neurologist or Neuro-Ophthamologist, but then decided to give me the referral to the second guy.  So if it isn't cleared up in a week, I can go there to check it out further.  

Felt very well taken care of, and really glad I went in today!  The Eye Doctor was so nice, and seemed genuinely concerned into checking it out as best he could.  He also told me if I noticed anything unusually strange, to go see the other guy.

Thanks Scooter for the advice to checking with my Eye Doctor.  He was less expensive, and easier to get in quickly than a GP or Neurologist would have been.  And he seemed to know what he was doing.  So far I have avoided expensive tests or Doctor visits.

Appreciate the help!
700950 tn?1228611035
So glad that you got it checked out. I have been thinking about you since I read it. Don't hesitate to make that second appointment if the pupil is still larger. Is your current eye doc an OD ir an MD?

One other thought? Do you have any eye pain or redness? Sometimes a condition call iritis can cause a dilated pupil. You are at high risk of this if you have arthritis. It is an inflammatory condition.
Avatar universal
I don't remember the exact title of my Eye Doctor, but he's very good and I have no reason to doubt his competency.  He did a thorough exam, and even looked up old medical books trying to help.  He also gave me a very good referral.  He went to UCSD Medical School, which is very good.

No, I don't have any eye pain or redness in the eye.  I do have general headache pain, because I have a sinus infection from an URI.  That is probably causing my headache, congestion, dizziness and light sensitivity.  Now I am into the itching/sneezing part of the sinuses as well.

It isn't Iritus, that is something else that the Eye Doctor would have recognized.  That would be inflammation of the eye and the inside of my eyes looked fine.  He did also note that I had a larger left pupil in the past, which could indicate this is normal physiology for me at certain times.  No, I don't have any sort of arthritis.  Are you sure you didn't mean Uveitis?  That would involved inflammation of the eye and tissues.

Thanks again for helping.  The pupil is still pretty dilated today, Saturday and in fact it looks a bit larger.  But I am extremely sick with the cold/sinus infection, and didn't sleep well last night.  The sinus symptoms are very acute and that could very well be causing the pupil to be so dilated.  Also, it can be caused by sleep deprivation and stress which  I have had a lot of lately.
700950 tn?1228611035
Your doc is an MD or DO  if he went to medical school. Good to know. Some people don't know that optometrists (ODs) have a degree more related to optics and glasses refracting. They refer out for eye health issues.

Yes, I did mean iritis. It is inflammation of the iris. It it usually causes headache, light sensitivity, and pupil dilation. Sometimes it is the first sign that someone has an autoimmune inflammatory disease. Many patients alrady had been diagnoised with arthritis. Many autoimmune diseases overlap and are related to each other. Whenever we had a patient with iritis that had never been diagnoised with an inflammatory condition, we referred them to a Rheumatologist. (Some of the inflammatory autoimmune diseases are Arthritis, Scleroderma (some types never effect the skin), Lupus, Fibromyalgia (suspected), and others).

If it turns out that you do have iritis, you should look into seeing a rhuem. Some autoimmune diseases have sleep disorders as a symptom, as well as neurological problems. You really have to be your own advocate because these types of diseases are often missed unless they are obvious (like arthritis).

Let me know how it goes. I am hoping for you that this is not brian issue.
Avatar universal
Thanks Scooter;

Strangely enough I do have a pretty chronic and severe auto-immune type skin disease of some kind, which I have lived with for about a decade.  Never really diagnosed but have seen about 12 doctors over the years.

It has never affected my eyes though, and it isn't  anything arthritic.  It's more from the Immune System, causing a severe inflammation to the nerve endings in my skin.  I do need to see a Rheumatologist for that when I can, as my Derms have not really been able to diagnose and cure it or manage it well.

Funny you mentioned a Rheum--I have one all lined up, but very expensive and with no health insurance I have to space these things out.  Hoping he can pinpoint what is going on and suggest appropriate treatment instead of guessing as my current Dr. does.

I am really sick with a URI and sinus infection, and that is probably contributing to the eye thing.  It's really hitting my sinuses hard.

But I wonder if seeing a specialist for the eye might lead to figuring out anything with my skin?  I've been tested for Lupus, and all sorts of other diseases but nothing so far.  Also the sleep element is interesting added in--I just went to the UCSD Sleep Center for that, but not sure about the treatment plan.  

Thanks so much for all your contributions!  They are very helpful.  If the eye isn't better by Friday (a week after my Eye Doctor) I will probably schedule with the Neuro-Ophthamologist.  But appointments are very difficult for me right now with the sleep disorder, and just got hit full blown with the cold so I don't really want to be sneezing in the face of another eye guy LOL.

Thanks for all the helpful tips--I've been wondering if there is a connection with all these symptoms.  I have clinical depression, OCD and anxiety (GAD), so who knows.

I am also wearing off a really bad reaction to Lunesta, which I took ONE pill the night before my sleep appt. so I could make a morning appt.  It caused horrible anxiety, confusion, depression etc. and is taking time to wear off.  I still don't feel like myself.  That might be affecting everything as well.

PS:  Not sure exactly what my Eye Doctor is, but he's very good and highly recommended in the community.  He went to UCSD Med School (I went to UCSD too and know it's a good University).  He doesn't dilate for exams however.  But he really checked me out the other day.  He's probably an Optometrist, but he referred me immediately to an eye specialist if the problem continued.
Avatar universal
PS:  Some other inflammatory auto-immune diseases are:

Guillian Barre (parasympathetic nervous system)
Myasthenia Gravis (muscles/tendons)
Bechet's Disease (blood vessels/vasculitis)
Kawasaki Disease (blood vessels/vasculitis)

(I'm a big fan of Mystery Diagnosis LOL).
700950 tn?1228611035
any update? Is your pupil still dilated?
Avatar universal
Hi;

I was waiting to update until I saw the specialist, but not sure when that would be.

Yes, the left pupil is still quite dilated.  It's about the same, sometimes can be pretty large.

But I also still have sinus problems, the remnants of a cold and possible sinus infection which may be contributing.  I have been waiting to give it some time to see if it clears up.  And my sinuses are still affected.  I have been taking low dose Keflex to help clear up the sinus infection, hopefully and not done with that yet.

My next step would be to see the Neuro-Ophthamologist, but it's expensive and where I just had to go to the UCSD Sleep Center (a drive) so not thrilled about that.  I did email that office to ask their opinion whether it was something that needed to be seen ASAP, or whether I should just give it some more time and see if it was sinus-related.  I haven't received a response, but just sent the email Friday morning.

Meanwhile I emailed my Dermatologist whom I have known for years, and gave him an update about all this.  Especially with the possible connection to eye inflammation and an auto-immune disease affecting my skin.  I told him I would let him know if this specialist found out anything significant related to my skin.

But my Eye Doctor already thoroughly examined my eye, and found nothing wrong inside or any signs of inflammation.  So who knows.  It can be caused by stress and sleep deprivation, both of which I have high amounts of currently.  He also seemed to think it mostly likely sinus-related, so I am not too worried about it.  Some medications can also cause it, and I take a lot of Benedryl at night.

I seem to be doing fine with the dilated pupil, being about 10 days since it was diagnosed.  Still experiencing some confusion, memory lapses, and what feels like minor cognitive impairment; but I believe they are related to the drug reaction I had 10 days ago also which caused the same symptoms.

So-waiting to see what happens this week, if the pupil continues to be dilated I will probably make an appt. to see the Neuro-Ophthamologist.  But so close to Christmas, and with a major sleep disorder appointments are very difficult for me.  I can never sleep the night before.

Thanks for your concern....

700950 tn?1228611035
I have been in Ophthalmology for 25 years and have never heard of an oral medication, sinus infection, or even stress causing only 1 eye to be dilated. ( I work for a pharma and medical device company and manage departments related to researching surgical complications). I just checked wiith the girl in the office next to me concerning this. She has a doctorate in pharmacy. She agrees with me, that oral meds will not cause only 1 eye to be dilated.

I am not a doctor, but it is my job to investigate and help opththalmologists understand complications and work through them. If I had a physician with a patient with your symptoms, I would immediately refer to a neuro-ophthalmologist as part of my investigation.

You may also want to look up Horner's Syndrome and see if the profile fits your symptoms.

Keep me posted. I work in research but I am forever curious. Good luck.

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