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Home > Archive > Lasik Eyes Surgery > January 2005 > Post Lasik Asymmetric Pupil Size
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Post Lasik Asymmetric Pupil Size
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| jdeshaies88@yahoo.com 2005-01-27, 8:52 am |
| Hi,
I had LASIK perfromed 6 years ago, and now have asymmtrically sized
pupils. My pupil sizes were symmetric before the procedure. This is
causing me alot of distress. I have problems maintaining eye contact
w/ people, and have cloudy vision later in the day, pain in my left
eye, and problems with depth perception esp. in dim lighting. My left
eyes pupil is larger than my right eyes pupil now. It also seems that
the less light that I am in, the greater the asymmetry of my pupils;
and the less clear my vision is in my left eye. I do have a small
amount of scarring on the cornea of my left eye (the eye that I'm
having trouble with) and have been told by the LASIK doctor that that
would not be the cause of my asymmetric pupil size. I feel that it
might be though. If anyone has any insight into my problem, I would be
very grateful to read any responses.
thanks for reading my post.
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| Glenn - USAEyes.org 2005-01-27, 8:52 am |
| What is your current age, sex, and what medications (prescription or
over the counter) are you currently using?
Glenn Hagele
Executive Director
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
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Glenn - USAEyes.org wrote:
> What is your current age, sex, and what medications (prescription or
> over the counter) are you currently using?
>
> Glenn Hagele
> Executive Director
>
> Email to glenn dot hagele at usaeyes dot org
>
> http://www.USAEyes.org
> http://www.ComplicatedEyes.org
>
> I am not a doctor.
The asmetric pupil size could be caused by nerve damage by the suction
ring durning the procedure. I know a guy who got hit in the eye by a
hockey puck who had permanently asymetric pupils. LASIK is also eye
trauma, as we are all well aware. Were your pupils asymetric
immediatlely after LASIK or did this devlop over time? The rest of your
symptoms relating to pain and poor vision seem typical of post-LASIK
complaints. Make sure you are a vocal opponent of this procedure and
stop everyone you can find from even remotely considering having their
eyes maimed by refractive surgery!
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| Glenn - USAEyes.org 2005-01-27, 8:52 am |
| Trauma does make sense, but not six years after the surgery. It seems
that LASIK would not be the cause, but may have exacerbated the actual
cause.
Glenn Hagele
Executive Director
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
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| doctor_my_eye@msn.com 2005-01-27, 8:52 am |
|
Glenn is tip-toeing around a sensitive issue here. None of us feels
good about making a diagnosis over the internet, especially without
having seen your eyes. He is hinting around the issues, but I'll take
his reasoning one step further. FOR EXAMPLE, there is a condition
called Adie's tonic pupil, which is a dilated and sluggish pupil on one
side. It happens almost exclusively in females, usually in their 30s.
It is believed to be caused by a paralysis of a ganglion of the 3rd
cranial nerve, and this paralysis can be caused by viral infections or
chronic inflammation. When you think of inflammation around the
cranial nerves, you must look into chronic auto-immune diseases like
lupus.
So, the bottom line here is that your refractive surgery cannot be
"ruled out" as a cause of your tonic pupil, it is an illogical cause.
You need a good work up with a neurologist, and possibly a
neuro-ophthalmologist to explore the reason for your dilated pupil.
A couple of years ago I started a thread that refractive surgery has a
tendency to lead to a "garbage can" diagnosis. That kind of diagnosis
is an old expression that describes when a doctor throws together a
bunch of signs and symptoms into a "can" and come up with a diagnosis
that can't necessarily be proven, right or wrong. IF your tonic pupil
is "written off" as a simple side effect of your surgery, the doctor
might have passed up other treatable causes (like a viral infection or
inflammatory disease).
Bottom line...treat your "new" open pupil as if you hadn't ever had
your eyes operated on, and go ahead trying to find what else might have
dilated your pupil. In my 25 years of practice I have had 3 brain
tumor
patients that have first presented with a dilated pupil on one side.
An undiagnosed diabetic can first present his disease as double vision
or a dilated pupil, and so can a hyperthyroidism patient. Go explore
all of your possibilities, and good luck!
Glenn - USAEyes. org wrote:
> Trauma does make sense, but not six years after the surgery. It
seems
> that LASIK would not be the cause, but may have exacerbated the
actual
> cause.
>
> Glenn Hagele
> Executive Director
>
> Email to glenn dot hagele at usaeyes dot org
>
> http://www.USAEyes.org
> http://www.ComplicatedEyes.org
>
> I am not a doctor.
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| serebel 2005-01-27, 8:52 am |
|
Tabby wrote:
>
> The asmetric pupil size could be caused by nerve damage by the
suction
> ring durning the procedure. I know a guy who got hit in the eye by a
> hockey puck who had permanently asymetric pupils. LASIK is also eye
> trauma, as we are all well aware. Were your pupils asymetric
> immediatlely after LASIK or did this devlop over time? The rest of
your
> symptoms relating to pain and poor vision seem typical of post-LASIK
> complaints. Make sure you are a vocal opponent of this procedure and
> stop everyone you can find from even remotely considering having
their
> eyes maimed by refractive surgery!
Okay Tabby,
Come back in off the ledge now. This person has asked for insight into
a specific problem which doesn't call for you to condemn RS for the
rest of the world. Hint: it's too late, already had RS. Also, this
person did not get hit in the eye by a hockey puck.
SErebel
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| doctor_my_eye@msn.com 2005-01-27, 8:52 am |
| Just a coincidence, I'm sure...but this morning's second patient
presented with a tonic pupil in her left eye. She was diagnosed with
nerve damage in her left shoulder a month ago when she fell down a
flight of steps, and her neurologist told her that her tonic pupil is a
residual effect from her fall.
serebel wrote:
> Tabby wrote:
> suction
a[vbcol=seagreen]
> your
post-LASIK[vbcol=seagreen]
and[vbcol=seagreen]
> their
>
> Okay Tabby,
> Come back in off the ledge now. This person has asked for insight
into
> a specific problem which doesn't call for you to condemn RS for the
> rest of the world. Hint: it's too late, already had RS. Also, this
> person did not get hit in the eye by a hockey puck.
>
> SErebel
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| Sandy - LASIKdisaster.com - LASIKmemorial.com 2005-01-27, 8:52 am |
| Is it permanent?
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| doctor_my_eye@msn.com 2005-01-27, 8:52 am |
| Which came first, the chicken or the egg? How long the tonic pupil
lasts is influenced by what caused it. If it was caused by
inflammation, it will respond again when the inflammation completely
subsides. But, if the tonic pupil was caused by actual physical damage
to the nerve, it may never function again. So, the answer to your
question is that the patient has to treat the neck with compresses and
anti-inflammatories and hope that the pupil returns to its normal shape.
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| jdeshaies88@yahoo.com 2005-01-27, 8:53 am |
| Hi Thanks for all the responses.
I am 31, M, and take any a multivitamin each day = Centrum Performance.
The LASIK doctor that I saw did say that the large pupil may be
neurological in nature.
Is there any chance that the scarring on the left cornea may cause eye
strain and upon the muscles getting tired during the day, the pupil
would become larger? Just wondering if PTK would be a possible
solution.
Thanks everyone for there input.
Glenn - USAEyes.org wrote:
> What is your current age, sex, and what medications (prescription or
> over the counter) are you currently using?
>
> Glenn Hagele
> Executive Director
>
> Email to glenn dot hagele at usaeyes dot org
>
> http://www.USAEyes.org
> http://www.ComplicatedEyes.org
>
> I am not a doctor.
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| Dr. Leukoma 2005-01-27, 8:53 am |
|
jdeshaies88@yahoo.com wrote:
> Hi Thanks for all the responses.
> I am 31, M, and take any a multivitamin each day = Centrum
Performance.
> The LASIK doctor that I saw did say that the large pupil may be
> neurological in nature.
> Is there any chance that the scarring on the left cornea may cause
eye
> strain and upon the muscles getting tired during the day, the pupil
> would become larger? Just wondering if PTK would be a possible
> solution.
> Thanks everyone for there input.
>
As has been mentioned, you may have an Adies pupil. However, an Adie's
pupil typically is non-reactive, or relatively non-reactive. If your
pupil is simply a little larger than the other, yet reacts to light the
same way, then it is simply physiological anisocoria.
Reframing your question, could it be that the pupil is enlarging in
order to "see" around the central scar -- if it is indeed central?
That's a good question, but difficult to answer because I haven't yet
come across a case like that. However, another possiblility is that
the other pupil is abnormally miotic (small) in response to excess
accommodation on that side.
It would be interesting to see the actual measurements.
DrG
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