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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: 2055
Experience:  MS Ophthalmology with 11 years of surgical expereince
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I had an annual eye exam and two days later my left pupil was

Resolved Question:

I had an annual eye exam and two days later my left pupil was dilated. The pupil gets bigger and smaller through out the day. My right pupil seems to be constricted according to my eye physician.

Also, my eyes are sluggish to respond to light both of them. Please help me understand what could be going on, please!
Submitted: 8 months ago.
Category: Eye
Expert:  Dr. A.S. Desai replied 8 months ago.

Dr. A.S. Desai :

Hello, Thank you for the question.I am Dr.A.S.Desai and I look forward to assisting you .

Dr. A.S. Desai :

Are you available for chat now?

Dr. A.S. Desai :

Pupil size and reaction is a direct indicator of optic nerve function.

Customer:

Yes, I am available to chat.

Customer:

are you still there?

Dr. A.S. Desai :

Abnormal size and reaction of pupils can occur with diseases of optic nerve, large retinal lesions, pupil supplying nerve pathways.

Customer:

Would a MRI with contrast be able to pick up any problems within the brain?

Dr. A.S. Desai :

I guess if any of these would have been there , your eye doctor would have seen them.

Customer:

I had an annual eye exam 3 1/2 weeks ago and all was fine. He said in my left eye I have a main artery and blood vessels are tightly wrapped around the artery. But, my pupils were fine until two days later after my eye exam.

Dr. A.S. Desai :

Yes, it can. But it does not seem to be necessary in your case unless there are other signs and symptoms suggestive of it.

Dr. A.S. Desai :

Do you know which dilating eye drop was put?

Customer:

No I do not have a clue?

Customer:

I have been told my eyes are sluggish to respond to light. But, a friend that works with an eye dr said yesterday they are not responding at all. I have an apt with her dr next week for a second option. If my eyes are not responding to light at all is that very dangerous????

Customer:

Are you still with me?

Dr. A.S. Desai :

It is very unlikely that you have no pupil reaction at all. Only torch light exam under varying room light can give rise to wrong interpretation.

Customer:

I asked the dr. about just upping my contact lens prescription so I could see. He said that would not matter until my pupils return to normal or settle down. I waited one week after my initial appt. to return to see him so he could see the dilation for himself and he said he was concerned with my right eye being restricted.

Customer:

Ok that is great --- because if my friend the tech at the other office was wrong - and they are still sluggish to respond to light that can be fixed and repaired? Your best answer with all honestly, please tell me what you think this problem could be, please.

Dr. A.S. Desai :

It would be better to confirm about the pupil reaction by the eye MD again. Sometimes the effect of the dilating eye drop could last longer than normal.

Customer:

ok. Why would I have sluggish response to the light? the actual eye dr. made that comment.

Dr. A.S. Desai :

Since the pupil abnormal reaction was noted after the dilated eye exam, it could be a delayed effect on the left eye. The right pupil could show reaction under proper illumination and when observed by an expert.

Customer:

The eye dr. when I went back said yes my LEFT pupil is larger dilated. However; he was more concerned with my right eye being so constricted. Please just if you would share your Dr. knowledge and let me know what he is thinking it could be, I would really appreciate it.

Customer:

Also he was concerned with the sluggish response to light and he even called his partner in there. He did mention I have poor circulation in my eyes - what could cause the poor circulation? NO I do not have high blood pressure.

Dr. A.S. Desai :

Small rigid pupil can be seen in case of iritis (inflammation), extremes of age, hihg hyperopia, Horner's syndrome, traumatic miosis.

Customer:

he mentioned pseo horner's syndrome???? pseo means FALSE?

Dr. A.S. Desai :

But you do not have any symptoms or signs of the above.

Customer:

signs and symptoms of what? You think there is nothing to worry about???

Dr. A.S. Desai :

Poor circulation would mean that the retinal nlood vessels are not supplying sufficient blood to the eye. This can be confirmed by doing a FFA -fundus fluorescein angiography test.

Customer:

Ok - do you think I need to go for a 2nd option?

Dr. A.S. Desai :

Do you have any knownbhistory of diabetes?

Customer:

I do not have diabetes; however diabetes runs wild in both sides of my family. I have very HIGH triglycerides.

Dr. A.S. Desai :

A second opinion with a retina specialist would be better if the previous eye doctor has noted a problem with blood vessels in the eye. High triglycerides can cause narrowing of the blood vessels. It is better to undergo FFA and also take treatment for high triglycerides.

Customer:

I have started treatment for my high triglycerides and I am now watching my trans fats and no red meats, fried foods etc. So What type of eye dr. would I need to research to make an appt. with?

Dr. A.S. Desai :

A retiba specialist.

Dr. A.S. Desai :

You can search using this website-www.aao.org

Customer:

Ok! so with everything I told you now you do not think it could be an optic nerve issue or nerve function? I really appreciate your time and knowledge.

Dr. A.S. Desai :

No, optic nerve problem causes dilated pupil and reduced vision.

Customer:

in a direct answer to the point - could sluggish to light be dangerous?

Customer:

Also, is this type of thing common? Am I over reacting and just a little to worried by chance? Is this a common problem?

Dr. A.S. Desai :

Sluggish pupil is definitely an indication of abnormal pupillary fibres. But a lot would depend on associated symptoms. It is common to have sluggish pupils with extremes of age and in those with diabetes.

Dr. A.S. Desai :

Is your present eye doctor an eye MD or an optometrist?

Customer:

My Direct dr. is an OD. He got his partner that owns part of the practice - Dr. Swan which he is a MD to come help him try to figure out what could be going on with my eyes. They informed me if they do not improve in 3 1/2 weeks they would start wondering if it could be cranial nerve 3. I have already had a chest x-ray and I do not have Pan Coast tumor - my chest is clear.

Dr. A.S. Desai :

Third cranial nerve palsy can occur as an isolated nerve lesion in those with hypertension or diabetes but majority are idiopathic (cause not known). It is associated with drooping of upperlid, double vision too.

Customer:

Ok! thanks so very much for your time and very smart answers. If I would like to chat with you in the future. How would I locate you?

Customer:

oh yeah one more question. How can the eye dr. tell I have poor circulation in my eyes?

Dr. A.S. Desai :

Areas with poor circulation in the eye have pale retina and this cab be confirmed by doing FFA TEST. A dye is injected in the arm and is visualised in the eye. Its images are captured by a special camera. Areas with poor circulation show less dye or no dye entry in them.

Customer:

Ok thanks so much! Do you think I am overthinking and over worrying about this issue? Couldn't it just be a minor problem?

Customer:

Also, when I was born 39 years ago I was born with a burst blood vessel in my head. ALL is well from that end. Then in 6th grade I had serve swelling on my brain and concussion from a car accident I was in. I suffer from migraines. Do you think by chance any of that could have anything to do with the problems I am having now?

Dr. A.S. Desai :

If any of the above were responsible for a small sluggish pupil, the vision also would have been reduced.

Customer:

Ok, Thank you so very much for your time this evening! Good night.

Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2055
Experience: MS Ophthalmology with 11 years of surgical expereince
Dr. A.S. Desai and 2 other Eye Specialists are ready to help you

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