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Ask Dr. Rick Your Own Question

Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7904
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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my daughters left pupil is about 20 % more dilated than the

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my daughter's left pupil is about 20 % more dilated than the right. She said she felt nautious earlier today and currently has a headache. She has not fallen or bumped herself.
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. Rick replied 2 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

Is your daughter available so I can ask you/her some questions?

Customer:

is this a serious condition?

Dr. Rick :

Hard to tell yet. I'd like to get some more information if possible.....

Customer:

what do u need to know?

Dr. Rick :

Did she notice any changes in her vision before she got the headache/nausea? Things like shimmering lights or problems reading, that may have lasted for 20 minutes or an hour or so and then just went away? Is her vision normal at the moment (test one eye at a time)?

Customer:

no her vision is not normal right now, she has been having vision problems since friday and she got a headache only around the left eye when she got to work today

Customer:

right before it she thought that she was going to pass out as she was driving to work

Customer:

once she got to work it appeared to her that she could see her pulse in her eye and she felt nauseous

Customer:

about an hour into the headache things appeared a bit grey to her just out of that eye (like there was smoke in the room)

Dr. Rick :

Ok. So let me understand this. She almost passed out on the way to work. Her vision is not normal and has been that way for over 4 days now....it has not gotten better, and it has not gotten worse. Is the poor vision in both eyes, or in the eye with the enlarged pupil? Please try to be as specific as possible as I can't see her :)

Customer:

her vision is just bad in the eye with the large pupil

Customer:

and she only has a headache on that side

Dr. Rick :

Other then almost passing out, does/did she have any other physical symptoms? Does she take any medicine or have any medical problems? Is it possible that she is pregnant?

Customer:

her headache has gotten better as the day went on but her vision has not, she took 3 extra strength excedrin over the course of the day

Customer:

no she is not pregnant

Customer:

and she does not take other medicine

Dr. Rick :

Ok. Thanks. In the eye with the large pupil is it her near vision that is defective, her distance vision (with her normal glasses in place) or both?

Customer:

and no other problems except nausea and a headache

Customer:

her near vision

Dr. Rick :

Any history of trauma?

Customer:

no history of trauma

Customer:

she does not wear glasses or contacts

Customer:

she still gets the pulse in her eye, but not when she is focusing on something, only when she zones out (if that makes sense)

Customer:

she can see it, its like when you see stars when you stand up too fast, except they are pulsing

Dr. Rick :

Ok. Well, in an otherwise healthy young woman, who is not pregnant and has no other systemic problems other then a unilateral enlarged pupil, blurry near vision and a localized headache with mild nausea (do I have this correct so far? Please let me know if I am off base....) the most likely cause of her problem is NOT a brain tumor, an aneurysm or any other of those horrible things that us parents are always worrying about....

Dr. Rick :

That is good news, right?

Customer:

yes

Customer:

should she take an asprin?

Dr. Rick :

Ok, then, what do I think is going on? I believe that she is suffering from an ocular migraine.

Dr. Rick :

Aspirin would be ok....

Dr. Rick :

A typical migraine headache starts with shimmering lights, often times they surround a blurry area or have dots or jaggedly lines associated with them. They tend to progressively increase in intensity and sometimes march across the visual field causing difficulty with reading. Many times this is then accompanied by nausea, irritability, sensitivity to bright lights and/or loud noises. After the onset of the lights (called scintillating scotomas), the headache typically starts and the light show tends to progressively go away.


Many people can have this migraine phenomenon without the headache; it is called an acephalgic migraine. Some people even start having these late in life, or may have had a few much earlier in life that behaved differently and haven't had any for decades and then begin to have them; this is not uncommon. A family history of migraines is often present as well.


This is nothing to worry about. It is not a sign of a more serious underlying condition, brain tumor or anything like that. If the episodes become so frequent that they are bothersome there are medicines that can be used to decrease their frequency or stop an episode once it has started.


I, personally, have been suffering from this condition for almost 30 years. I almost never got the headaches after the visual effects but it doesn't seem like your daughter is as lucky as I've been :(


 

Customer:

she has gotten migraines before, but has never experienced this type of thing, it is usuaully unbarable and she has to stay in bed all day. is it normal that the pain would be barable enough woth an ocular migraine for her to stay at work?

Dr. Rick :

This can be very scary but, really, it is not a sign of anything terrible. It doesn't need a trip to the ER for an MRI etc.

Dr. Rick :

Yes. I've had all levels of migraines, from the ones that put you in a dark, quiet room for 3 days to the ones that have you walking around just sorta nauseous.....

Dr. Rick :

There was one time, I was in the middle of a very delicate retina operation, when an attack started. After a few moments I, like you have noted, lost most of my central vision and the inferior part of my visual field. I, calmly, removed my surgical instruments from the patients eye and we all sat around in the OR for 15 minutes until my vision returned. Other then that my ocular migraines have not really caused me any significant problems :o)


 

Customer:

Would it be helpful to check with an optometrist tomorrow?

Dr. Rick :

Does this make sense to you? Do you feel less panicked yet? I know, as a father of 3 daughters and 2 sons, how a call like the one you seem to have to got from your daughter can raise you blood pressure....

Dr. Rick :

I'd not waste my time with an optometrist. It wouldn't hurt, however, to see an ophthalmologist in the near future just to make sure everything is OK with her eye....although I am sure it will be. Unequal pupils (anisocoria) is very common with this condition.

Customer:

the info is a relief since there are some scary scenarios that show up on google with this, such a brain tumors or aneurisms etc

Dr. Rick :

ya....there sure are....but I don't think you have to worry about them in your daughter right now :o)

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7904
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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