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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3343
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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We went to a pediatric opthamologist to check our

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We went to a pediatric opthamologist to check our just-turned- 2 year old son's eye after he'd sustained a direct hit by a large frisbee. There is a bit of blood in the front of the eye right now, and they checked behind the eye and saw no blood. They're worried about pressure, but because our son is very sensitive and wouldn't settle down the remainder of the exam they couldn't get a good read. What I'm concerned with, was his reaction to the drops they gave him to dilate his pupils. He had a major mood swing - he can be sensitive to all medication and additives, not allergic, but with a bit of a mood swing (i.e. aggression, frustration and sudden shift in energy levels). We're wondering if we should get a second opinion as he prescribed THREE sets of drops for his eye. Prednisolone 1% which is a steroid and has me worried, Atropine Sul 1% Op Solution (dilates and may cause mood swings), Dorzolamide-Timol OpSol.

Hello and thanks for your question.

I can certainly understand your concern with your son's reaction to the drops. What is most likely the culprit is the Atropine. Atropine can cause an excitability or irritability as a common side effect. You may consider asking the doctor to prescribe a dilating drop that is not quite as strong such as cyclogyl.

That being said, if your son has a hyphema (blood in the front part of the eye), then for the most part I agree with the treatment. He needs a steroid (prednisolone) to decrease the inflammation, and if he's on the dorzolamide-timolol combination drop it is because they are worried about the pressure in the eye being elevated.

What is most important about your son's situation is that he remain calm and relatively inactive because if the clot that is forming in your son's eye breaks open and bleeds again, then his risk for further complications increases significantly. To that end, I do think it would be worthwhile to ask to get the different dilating drop.

Also, I never think it is a bad idea to get a second opinion when you have concerns about the course of treatment. At the very least you will either get some reassurance that the course you are taking is the correct one, or you will get a differing opinion that you may trust more.

Does that make sense and does that help address your concerns?

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My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must be examined by your doctor.

Customer: replied 6 years ago.
Hello thank you for your thorough reply. I am wondering why our doctor would prescribe the medicine for pupil dilation. Also, my husband wonders if we should skip the treatment tonight altogether and get a second opinion tomorrow? I'm thinking perhaps doing the two medicines for pressure and prednisolone would be best and getting a second version of the atropine tomorrow might make sense since our son hasn't been sleeping well and complaining of his eye at night.

I think it is a reasonable thing to continue with the prednisolone and the pressure drop and hold on the atropine for the night until a second opinion can be reached tomorrow.

The atropine, or cyclogyl for that matter, is a dilating drop. That dilating drop will help the pupil not scar down to his lens which can happen in this type of inflammation. The dilation also helps with the pain to a degree. That's why I still think he needs the dilating drop, but the cyclogyl may be the better choice because the side effect profile is better and you still accomplish the same thing.

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