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Ask Dr. A.S. Desai Your Own Question

Dr. A.S. Desai
Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2127
Experience:  MS Ophthalmology with 11 years of surgical expereince
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I have post op cataract anisocoria after R eye lens extraction

Resolved Question:

I have post op cataract anisocoria after R eye lens extraction and replacement on 2/25/13. Had severe R eye pain 3 hours after surgery and next day pressures were measured at 39-43 range. I was told many years ago that I was a "glaucoma suspect" I started several different glaucoma drops along with Diamox a few days later. We continued to measure the pressures daily and I spent 4 hours in the office for 2 days having my eye drained of fluid and pressures monitored. One week later my docter discovered that I had a "soemmering ring" due to left over old lens debris and therefore we had to go back in on 3/5/13 for re-extraction and after second surgery I had a small stitch placed at the same insertion site. I am off all the glaucoma drops and Diamox (awful side effects) and am still using Durezol and Bromday daily. My pupil does not constrict with light and stays at about 5-6mm and is not completely round as before surgery. My vision has improved and I was corrected with a Toric Acry sof iQ lens for distance vision. I was wondering your opinion on whether I may have suffered permanent nerve or muscle damage to the iris? Or is it a matter of time the pupil size will decrease? I am also a nurse practitioner. Please advise.
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. A.S. Desai replied 1 year ago.

Dr. A.S. Desai :

Hello, Welcome to Pearl.com

Dr. A.S. Desai :

Are you available for chat now?

Dr. A.S. Desai :

Have been put on any mydriatic ee drops such as homatropine?

Dr. A.S. Desai :

Retained lens matter with post op inflammation could have caused a rise in intraocular pressure. For how long these antiglaucoma would be continued would depend on the inflammation in the eye.

Customer:

I am off all anti glaucoma drops as mentioned. And no, have not been Rx'd any mydiatic drops, only the ones they used during surgery on 2/25 and 3/5.

Dr. A.S. Desai :

If the pupil remains dilated inspite of wihdrawl of mydriatics, then we need to consider the possibility of iris spinctre muscle damage as a cause provided the post op vision is good enough.

Customer:

I know the retained lens matter most likely caused the increased ocular pressures. I am concerned about the anisocoria and permanent nerve or muscle damage to the iris.

Dr. A.S. Desai :

How is the visio in he right eye now?

Customer:

How is the damage to spincter muscle diagnosed and is this correctable for pupil to constrict back down to normal size. My opthalmologist reports that he does not know why my pupil remains dilated as it has been over 2 weeks since second surgery.

Customer:

Vision is about 20/30, there is still a vague cloudiness.

Dr. A.S. Desai :

Before comenting on permanent iris spinctre damage , it would be helpful to know if the optic nerve is fine and not swollen as in case of optic neuritis whih is a known cause for mid dilated pupil.

Customer:

My optic nerve is good, in fact everything looks great according to my doc, all except the pupil still being dilated.

Dr. A.S. Desai :

But in presence of a healthy optic nerve, iris spinctre damage is a possibility.

Customer:

So do you know how this could be diagnosed or possibly corrected in any way?

Dr. A.S. Desai :

Spinctre can get damaged either by stretching during surgery or due to tears during surgey. In such cases the dilated pupil may not appear very round but could be distorted.

Customer:

So this is a diagnosis of exclusion? and I gather no treatment available if is the case of muscle damage?

Dr. A.S. Desai :

It can be identified by slit lamp exam in the ophthalmologist office. If he tears are present, these can be sutured to make the pupil smaller . But a stretched pupil is likely to remain so. The other way to know if he muscle has still got functional properties is by instillation of miotic eye drops such as pilocarpine.

Customer:

We did use pilocarpine as an experiment when I was in the office 4 days ago and the pupil did decrease a bit, but grew back as the day progressed. Good sign or bad sign?

Dr. A.S. Desai :

Pilocarpine is usually avoided post operatively due to a small risk of post op iritis or retinal detachment. If the pupil did constirct, hen it is better to wait and watch as it would show that there is residual function still.

Dr. A.S. Desai :

Is there anything else that I can answer for you?

Customer:

I was 2 weeks post op from second surgery and the stitch had been removed a week prior when we tried the Pilocarpine 4 days ago which did help but only for a s few hours. So at my next FU in 3 weeks, we should eval with slit lamp for any tears? He told me that all was good though and would have seen them 4 days ago I would imagine.

Dr. A.S. Desai :

Yes if there were tears he would have seen them.

Customer:

Could these so called stretches or tears heal spontaneously with time, and with a trial of using the Pilocarpine again in a few weeks, could this be re-evaluated?

Customer:

So tears can be seen but not spincter muscle damage via slit lamp? Wondering if the muscle damage is as assumed diagnosis then?

Dr. A.S. Desai :

The tears would heal but would not bring the pupil back to original size.

Dr. A.S. Desai :

Yes muscle stretch is a possibility.

Customer:

What about muscle damage, wouldn't this heal spontaneously as well and possibly constrict pupil with time?

Dr. A.S. Desai :

To some extent yes, we can wait for some more time and ty wih pilocarpine.

Customer:

Just trying to determine any other possible causes of post op cataract anisocoria and what probability this will be permanent??

Dr. A.S. Desai :

The other would be optic neve dysfunction, but unlikely in your case as vision is good.

Dr. A.S. Desai :

Does that make sense?

Customer:

Yes, makes sense. So in all likelihood, it is most probable that I have either tears or spincter damage to iris muscles, correct?

Dr. A.S. Desai :

Correct.

Dr. A.S. Desai :

Is there anything else that I can answer for you?

Customer:

Will just give it more time and see what happens. Would rather have the other pupil a bit enlarged to match....Thank you

Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2127
Experience: MS Ophthalmology with 11 years of surgical expereince
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