5/4/2023 0 Comments Pupil dilation drops![]() In a really busy surgical center, where the bottles of dilating drops have red caps on them, someone could have grabbed the atropine by mistake,” said Nick Mamalis, M.D., professor of ophthalmology, John A. When an eye diffusely dilates like this patient’s eye did, “you have to rule out that atropine was given. “By the time the patient was seen the next day, the IOP could have returned to normal while the sphincter damage is still present.” This would typically only occur with very high IOPs that should normally alert the patient with symptoms of ocular pain and/or headache,” said Arthur Cummings, F.R.C.S.Ed., medical director, Wellington Eye Clinic, Dublin, Ireland. Increased IOP overnight “could damage the iris sphincter and one finds a widely dilated, non-responsive pupil afterwards. In that instance, however, “I would expect the patient would have had some pain and nausea in the evening of the surgery.” ![]() ![]() ” Dilated eye Potential causesĪ permanent, dilated non-reactive pupil “can be caused by very high post-op pressures due to retained viscoelastic,” said Luther L. “This was a compliant patient, who denied using any drops other than the prescribed Pred Forte, Acuvail, and Zymar. This was his second surgery with me his first cataract operation had been 3 years earlier, and there were no post-op complications,” said Dr. “There was no stromal edema or the epithelial microcystic edema one would expect to see after a prolong episode of high IOP. Intraocular pressure was 16 mm Hg, the cornea was clear and the patient had minor cell and flare (+1) in the 12-24 hour post-op period, Dr. The patient’s uncorrected visual acuity of 20/200 only pinholed to 20/50. So when a 78-year-old male who had undergone routine uncomplicated clear cornea phaco under topical anesthesia presented on post-op day 1 with a completely dilated and non-reactive pupil in the operated eye, Ernesto Collazo, M.D., San Juan, Puerto Rico, was concerned. And in cases where the first eye dilates poorly but the surgery is uneventful, surgeons are prepared for the second eye to also dilate poorly. When it comes to cataract surgery, minor inconveniences, such as pupils that do not dilate well, add a bit more stress for the surgeon, but are by no means insurmountable obstacles to performing the surgery. According to a January 2006 "BMJ" review article, the risk of acute angle-closure glaucoma due to dilating drops is significantly less than 1 percent 7.Cover Feature: Challenging cataract casesĮyeWorld Contributing Editor Presenting with a “completely dilated and non-reactive” pupil on post-op day 1 can be nerve-wracking for the surgeon … Here’s how one physician dealt with the complication The increased pressure can damage the eye nerves, potentially causing vision loss.ĭilating drops can trigger a form of glaucoma called acute angle-closure glaucoma, characterized by an abrupt increase in eye pressure due to obstructed outflow of the aqueous humor - known medically as closure of the anterior chamber angle 7. Glaucoma is a group of eye diseases characterized by increased internal eye pressure due to buildup of aqueous humor. The amount of fluid remains constant as fluid is produced and drained at an equivalent rate. Clear fluid, called the aqueous humor, circulates through the front chamber of the eye. Acute angle-closure glaucoma is a very rare, but serious adverse effect that can be triggered by pupil-dilating drops.
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