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The effects of the dilation could still be present especially if atropine or hom-atropine were used. On the mydriatic front, because the first eye was a challenge to dilate, “this could have led to a more aggressive dilating regime by the nursing staff in order to achieve maximal dilation in this eye. The vision only pinholed to 20/50, but with a clear cornea, so you have to ask why is the vision only 20/50?” It would be very uncommon to have a clear cornea the next day. If you had a high enough pressure, you would have corneal edema the next day or a history of complaint of pain. “One factor that can do this consistently is high IOP. “There was something that shocked the pupil dilator muscle,” he said. Mamalis said the effects wear off in about 7 days.

If the problem was caused by atropine, Dr. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City. 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. 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​