Enlarged Pupil

[lauriab]

Hi all,
I am just (hopefully) finishing up my first diagnosed attack of iritis. I'm an otherwise healthy person - no autoimmune problems that I know about. I'm sure I've had iritis before, maybe 4 times in the last 10 years but never diagnosed. I got told it was allergies, pink eye, maybe I got detergent in my eye. In any case, it was never very severe and went away on its own in a month or two. Really it was only a cosmetic problem to me.

But this most recent attack was more severe. I was in quite a bit of pain and my vision was affected - I felt like I was looking through a dirty window. Everything was grey and lights had big halos around them. Also, my affected pupil was smaller than the other. So I went on pred forte, with maxidex at night and homatropine to dilate. It cleared up right away and I slowly reduced my frequency of drops over a few weeks until I had stopped. Then after a few weeks it came back, but milder, so now I'm on a low dose of pred forte and am going to wean off more slowly. I never got a severity number when it was at its worst, but the milder case was a +1 to +2, so I'm thinking when it was severe it was at least a 3.

Anyway, that's the summary. My question is, does anybody know why my pupil is still enlarged? The homatropine worked very well on me. It took at least 5 days to wear off when I stopped using it. And now my affected pupil is still a little larger than the other one, even though it's been about a month since I used it. Is it a long term effect of the iritis itself, or could it have been caused by the homatropine? Has anybody else experienced this? Will it go away? My opthalmologist seems unconcerned, but it bothers me a little. It's not THAT noticeable, especially because I have dark eyes, but it looks weird to me. I'd just be interested in hearing anybody else's experience with a slightly enlarged pupil.

Lauria

[mtbargeman]

Hi, Lauria!

Enlarged pupils can last for weeks after stopping homatropine, especially if you took it for a while, or at a high dose. Iritis also can cause the eye to become "stuck", because the iris can stick to the lense of the eye. Your doctor should be able to help you with this. Is your doc a specialist in Ocular Inflammatory Diseases? If you aren't sure, of your doc does not specialize in OID, check the list found on this site, and find the nearest one to you. It is very important to take close and careful care of your eyes. Vision problems and loss can become permanent quickly. Once your vision is gone, it's gone. It isn't like you can get and 'eye aid', like you can get a hearing aid if you lose hearing. Be careful.

Good Health, Good Care.

Mary

[Mike Bartolatz]

usually the iris will fully close after a few weeks as long as there is no adhesion between the iris and lens. there are causes that can permanently prevent the iris from functioning however and an Ocular immunologist can look into them if the iris is not working at all. does your eye dilate fully when in the dark? is it mishapen?
if only one eye is involved and if it no longer functions, and if there was allot of synechiae present and if now there are thin spots in the iris or 'holes' it might be related to the herpes Sx virus (usually intra ocular pressure is a problem.

the visual stuff you describe is called 'flare', protein shed by the cells and can be noticeable when there is allot of inflammation. it is measured separately from inflammation, both on a scale of 1 to 4 with 5 being one heck of allot of inflammation going on.
where the 'flare' is located such as in the vitreous, would indicate that a more severe form of uveitis is going on as more than just iritis is occuring. Only an experienced opthalmologist who has treated allot of uveitis patients who has extensive training in treatment of this can help you determine the course of treatment required to stop the recurrent or chronic nature of it.

wish you the very best,
mike

[bmats16]

Hi,

I have the same problem of the eye that I used the atropine being dialated still and it is causing blurry vision with blurry spots. It's been three weeks since I have stopped taking the atropine but my eye is still dialated. I'm working out more hoping that it will cause the medication to wear off sooner, you think it will help? The problem that I did was that I took the atropine by accident again on Saturday and Sunday. I thought it was the Prednisolone. So my eye became more dialated. I was healthy person before my iritis attack last month and is very concerned about my blurred vision still. I hope it will get better soon. I want to go back to work. Hope you are doing well.

Brent

[Mike Bartolatz]

atropine is the strongest dilating drop you can use and takes the longest to get out of your system. so you most likely will have to wait a few more days to get it out of your system completely. steroid eyedrops can impact this a little too but all should return to normal within a week or so once off of all eyedrops. if not, go back to the opthalmologist to explore reasons why the iris stays dilated. some viruses such as the herpes sx virus can cause the muscle that opens and closes the eye to be permanently damaged or adhesion between the iris or lens can cause the pupil to remain enlarged.
if herpes is suspect, usually there is an extreme rise in pressure inside the eye. it only affects one eye too.
if the HLA B27 gene is present, that can cause iritis that moves back and forth between eyes in some individuals. both eyes can be impacted at the same time however. if no virus or other pathogen is suspect, then a trial of prescription strength Non Steroidal anti Inflammatory meds could be tried as it is the immune system that has to be re taught to stop attacking the eye by mistake. Celebrex, dolobid and naprosyn are NSAIDs that work in about 70% of autoimmune (HLA B27) uveitis. these drugs can also be used in other autoimmune diseases not linked to the HLA B27 too. you would know within about six months of NSAID therapy if they will work for you. if you are get to 'off all steroids without inflammation' then the 2 year window of NSAID treatment would begin the day that the opthalmologist finds this to be happening. then once two years has occured you would halve the dose to once a day for about six months and then stop.

there are over 85 things directly linked to uveits including diseases and pathogens, chemicals, drugs etc so that is one of the reasons we suggest that a very highly skilled opthalmologist, an ocular Immunologist become involved to sort all of this out. the specialist will then work with other medical professionals to treat the underlying cause and he will ensure that your eyes remin quiet.

wishing you the very best,
Mike

[fraja1208]

I have the same problem. After stopping the dilation drops for a couple of months and the steroid drops for 3 weeks, the pupil in my effected eye is still slightly larger. From what I've been reading, this happens to a lot of people with iritis. My doctor said it could be scar tissue from "sticking", which definitely did happen in my case.