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Dr. Tom
Dr. Tom, Board Certified MD
Category: Eye
Satisfied Customers: 263
Experience:  30 years experience treating patients with eye problems
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I have anisocoria secondary to cataract surgery, I have no

Customer Question

I have anisocoria secondary to cataract surgery, I have no other sx. of issues such as disease or damage. No stroke sx. etc. the only issues that I have are miosis of the effected eye and extreme nearsightedness and astigmatism, my opthamologist is not forthcoming and is sending me to a neuro opthamologist, after the cataract surgery I did feel that I had something in my eye and experienced some "twitching" type impulses to the outside of my right, dominant eye on which the surgery was performed. My doctor inisisted that I could not feel that or it was just "dry eye", however, the lens was not completely centered and had to be moved surgically after which I was given 4 doses of Diamox to take orally. Although I have let my eyes get dry at times I have not felt either of those sensations since the second surgery. I was using Sandoz products, prednisolone and corticosteroid after the surgery. When this was discovered my MD did give me Bromday and Lotemax. I have not been able to find any information on how I can mitigate this annoying miosis and have to wait still another two weeks to get to the specialist. Meanwhile my distance vision is severely compromised. My MD says that there is no damage to my eye whatsoever and he has no idea of what is causing the miosis.
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Tom replied 1 year ago.

Dr. Tom : Hi, I'm online now and would be happy to help you with your question. Just reply and we'll get started. Dr. Tom
Customer :

Will this resolve spontaneously? What was the cause?

Dr. Tom :

Great, it appears you are available to chat, give me a minute to put some thoughts together for you.

Dr. Tom :

If it was necessary to reposition your intraocular lens after your primary surgery, although occasionally this is necessary, unfortunately we have to consider this at least a minor complication. And given that it was necessary for you to take Diamox, there is a reasonable presumption that you had post operative elevated intraocular pressure. Either of these could have a permanent or a transient effect on the ability of the iris to respond in a normal physiologic manner. You asked what is the cause? It is certainly possible that the elevated intraocular pressure damaged the nerves involved in the normal movement of the iris, and accordingly, the pupil size. If this is the case, there is the possibility that it will resolve or improve spontaneously with time. After you have seen the neuro ophthalmologist, you will have a much better idea of both the cause, and the potential for spontaneous recovery. Let me stop at this point to see what further questions this may have brought to mind.

Customer :

If it was due to intraocular pressure would that not have caused headache or other sx.? I did not have any. Also I have had the sensation of light moving rapidly up or down again to the outside of the effected eye. I experience this periferally and it is intermittent and does not seem related to any particular thing that I am doing. The near-sightedness and astigmatism are things that the surgeon says can be mitgated wiith lasix but he wants to wait until the eye has had a chance to heal. What was the sensation of having something in my eye caused by? He denied that was possible since there are no nerves in the effected area? Yet it is gone since the repositioning. It was a laser cataract surgery and the lens was the top of the line as well I have a card indicating the type that I can get if needed.

Customer :

Also I did see the DO the next day after the surgery and again the day after repositioning. He did not indicate any problems but I was unable to read the charts due to the nearsightedness and astigmatism.

Dr. Tom :

That's a lot of questions in one paragraph, so if you'll allow, I will answer them one at the time, after which I'll be glad to try to help you with anything else. Just give me a minute to go through each of them before you post any other questions.

Dr. Tom :

First question. If it was due to intraocular pressure would that not have caused headache or other sx.? This is a good point, and usually patients with highly elevated pressure do indeed feel pain, or at least discomfort. So it's gratifying to know that you did not. The second part of the first question was asking for" other surgery"by which I take it to mean, would it necessitate further surgery for elevated pressure. The answer is not necessarily.

Dr. Tom :

Second question, answer to follow.

Customer :

therefore it was determined that I would see the surgeon again and he advised of the need to re-position, he expected that my sight at that point was going to be great. But that is when they discovered the nearsightedness and astigmatism finally. I was the one who pointed out the arisocoria. He tested for reactivity to light which I had already asked my daughter to do and my eye is reactive to light.

Customer :

But it is slow and minimal

Dr. Tom :

Your second question was "What was the sensation of having something in my eye caused by?"... There are so many reasons to choose from, however the most common would be something to do with the surface, tear film stability, or a dry eye type of problem. Microscopic defects in the conjunctiva or cornea can certainly give us a sensation of having something in the eye. Further, internal ocular causes are also a possibility. Such as the elevated pressure, or possibly even some minor structural issue with the configuration of the iris. What you think about this. I will go forward to your third question.

Dr. Tom :

It is good news that you say that when you're daughter tested your reactivity to light that even though it was slow. There was was a minimal reaction. That indicates that you have not had permanent neurological damage to the iris nerves and muscles. I'm trying to keep up with your questions, but you made a lot of statements, and I'm not sure which to address now. So if there is a specific question that we haven't covered, please ask it, and give me time to answer it before adding new information. That just helps keep us from talking over each other

Customer :

Lens is ReSTOR 27 OD

Dr. Tom :

. That's a great intraocular lens. Do you have a question about it?

Dr. Tom :

By the way, it is the central part of that type of intraocular lens, which provides near vision. That could explain why, with the small pupil you currently have, your near vision would be good for your distance vision would be less clear.

Customer :

Sorry about adding the additional info I thought it would be helpful, I have read everything possible on the internet and nothing seems to address my problem so I wanted to give you all that I could to assist you to make good judgments. My next question would be if the pharmacologicals might be the cause of the miosis? either the anesthesia or the follow-up tx.

Dr. Tom :

"My next question would be if the pharmacologicals might be the cause of the miosis?"... Either the anesthesia or the follow-up tx". It is not likely that any IV sedation you may have had would have caused your smaller than normal pupil. My chat room hunch, without doing a physical examination, is that your pupil reactivity is a result of elevated pressure, but the neurophthalmologist will be able to give you a definitive answer. Has that been helpful?

Customer :

One more thing I question, is the miosis causing some of the nearsightedness? I realize that the surgery could be the reason for the astigmatism. If the miosis were resolved would the nearsightedness be effected?

Dr. Tom :

Yes, given that you explain to me the type of intraocular lens used, the miosis is very likely the cause of the nearsightedness. And yes, if the miosis is resolved and your pupil resumed a normal tone, it would be expected that both your distance and near vision would improve. You are correct about the astigmatism, and it sounds like your surgeon is prepared to deal with that when the time is right. I'm glad to have been available and to have been of some help to you today. Knowing that you have extensively researched the Internet and have not found a specific answer, is sort of confirmed by our conversation today. Yours is not a simple straightforward situation in which a quick answer solves the problem. But I do think that your miosis is the cause of your your nearsightedness, because that miosis is concentrating the visual images on the part of your implant that is designed to see clearly at the near point. The cause of that miosis will likely be determined by the neuro ophthalmologist....... and a medical course to improve your pupillary reaction can be found. Best wishes.

Dr. Tom :

Since it appears that you are satisfied with your answer, I will switch to the Q and A . Please rate my help to you today with a big smiley face. you can always return to ask more questions after checking out. Again..thanks.

Dr. Tom, Board Certified MD
Category: Eye
Satisfied Customers: 263
Experience: 30 years experience treating patients with eye problems
Dr. Tom and other Eye Specialists are ready to help you
Expert:  Dr. Tom replied 1 year ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

What happens now?

If you haven’t already done so, please rate your answer above. Or, you can reply to me using the box below.
Expert:  Dr. Tom replied 1 year ago.

Mary...again..it was a pleasure to help you. Ask for me personally in the future if you have any other eye questions. Thank you.

 

BTW...it is only by your satisfactory rating that we JA Experts are compensated by a portion of the fee you pay....so please let me know if there is anything further that I can do to get your positive rating?

Customer: replied 1 year ago.

I do appreciate your help and I will see the neuro on 03-28. Your answers helped me to have more confidence for which I thank you very much. I did rate you excellent as a result.

Expert:  Dr. Tom replied 1 year ago.
Thank you again.

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