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Dr. Stan
Dr. Stan, Ophthalmologist
Category: Eye
Satisfied Customers: 2701
Experience:  Johns Hopkins Fellowship Trained, Certified and Licensed Medical Physician and Surgeon
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His pupil responds extremely..size of a head of a pin) of the iris

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My question concerns a persistent dilation of the patient’s iris 12 weeks after ceasing use of atropine (after about seven weeks of use) (4 months subsequent to vitrectomy surgery and 4 and a half months after laser retinal surgery):

My principal question is what are all the treatments available to correct a persistently dilated pupil when the condition is treatable (I am aware that some conditions may be irreversible).

The patient has already tried pilocarpine for approximately a week. His pupil responds extremely well to the solution of 1% pilocarpine with an immediate and substantial constriction (to the size of a head of a pin) of the iris for approximately 24 hours. However, the iris returns to its original size thereafter. Additionally, he appears to have negative side effects such as waving lines and rectangular imaging in his field of vision from taking the drops and there is concerned about the possibility of the pilocarpine precipitating retinal detachment. (The more natural and noninvasive the treatment the better.)

Most importantly, what are the treatments (especially nonsurgical) available to cause the iris to once again begin to function. I would like a list irrespective of the cause as the cause cannot be determined.

Your input and recommendation for treatments would be much appreciated.

Most Sincerely,

Dr. Steve Sayre

Welcome to Just Answer:

Based on the history, it appears that there is iris atrophy with consequent loss of cholinergic receptors and/or innervations to the iris constrictor muscles. This is the reason for the temporary contriction and lack of sustained constriction after atropine. The caused of such atrophy is likely surgical trauma combined chronic dilatation with atropine. It is possible that the receptors may regeneration if the iris constrictor muscle regain strength over time. The regain of function from atrophy (though may not be obvious to the naked eye) will take some months. Regular use of lower strength pilocarpine (0.25%) twice daily, in addition to using over the counter Zaditor eye drop twice daily to soothe the eye and prevent aches or fatigue as needed. The risk of retinal detachment is very minimal with low strength pilocarpine.

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Edited by Dr. Stan on 3/4/2010 at 11:01 PM EST
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Customer: replied 7 years ago.

Thank you for your response. I was uncertain as to whether I should press "Accept Answer" before or after the Reply as I am not certain I will be able to contact you after hitting the Accept button. Please clarify that issue. I will do as you instruct.


My follow-up question is: (1) whether it might be advisable that he proceed without the pilocarpine due to the adverse reaction he has already had and; (2) Are there any natural approaches to treatment?


Thank you,


Dr. Steve Sayre


Thank you so much for your reply.

Without any intervention, the iris constrictor muscle will regain strength, however, it is difficult to predict how long (may be several months). The only natural approaches to constricting the pupil that I'm aware of include near accommodative and/or bright (pen light) exercises. With near accommodation , you focus on the tip of pen held with your hand as you slowly bring toward the tip of your nose. You go back and forth for about ten reps, then repeat few times each day. Alternatively or in addition, you can intermittently shine bright light in the affected eye to stimulate constriction. It is possible that over time these exercises could speed up recovery of function.
Customer: replied 7 years ago.

Thank you very much for your well considered and expert advice.


All the best,


Dr. Steve Sayre

You are welcomed. God bless.