Calling all medical personnel! My eye is all screwed up...

rexnervous · November 28, 2002, 4:37am

For the past 7 hours, my right eye has gone from being fully dilated to only partially so, for no discernable reason. It also feels like there’s something in it (tho’ I’m reasonably certain there isn’t), there’s a very slight “pain” if you could even call it that. Could be psychological, but also feels like the eye is swollen, though it’s not at least as I and my wife can tell. Needless to say, it’s been a real pain in the ass, and just a tad worrying.

Here’s what happened around the time I noticed this. About 4pm, was in boss’ office chatting about work, and my eye started bothering me, like something was under my contact lens. I did a little rubbing, and also moved the lens about with my finger, which usually does the trick. It didn’t.

My boss offered some over-the-counter eye drops, something recommended by his doctor for a minor issue he had. I was skeptical, but looked at the bottle and it seemed innocous, just mentioned lubricating dry eyes and getting the red out, so to speak.

So I removed my lens, and rinsed it with this stuff. First time I put lens back in, it still felt like something was there, so I repeated the process. Got the lens in, went back to his office, and then for next 15 minutes my eye burned like hell, tearing up and all. Gradually that went away, and all seemed more or less ok.

On my way out the door, I stopped at a mirror and went ‘Holy Shit!’. My right eye was completely dilated, the iris basically filling up the whole part of the eye (the colored part, whatever it’s called). Driving home at night with this sucked.

Anyway, got home, took out my lenses, and it’s been VERY SLOWLY de-dilating, even now it’s still half-dilated. With associated symptoms mentioned above.

Anyone know what the heck is going on?

Duck_Duck_Goose · November 28, 2002, 4:53am

Gee-zus. :eek: Just on a hunch I put “pupil dilated stroke” into Google and up come all kinds of brain aneurysm websites, too.

http://www.aao.org/aao/news/eyenet/neuro_oph/neuro_oph_sep.cfm

The true neuro-ophthalmic emergency is relatively rare. But can you tell the difference between conditions that need immediate attention and those that can wait?

Pseudo vs. Real
The ophthalmologist on the front line must know how to separate the pseudo-emergencies from true sight- or life-threatening conditions. “Many acute signs and symptoms aren’t emergencies,” said Nicholas J. Volpe, MD, associate professor of ophthalmology and neurology at the University of Pennsylvania. “Pseudoemergencies are far more common than true emergencies.”

However, certain symptoms are clues of impending catastrophe—and if you ignore them during the examination, the patient might go blind, have a stroke or rupture an aneurysm.

The Warning Signs
When a patient presents with the following symptoms, you may be dealing with a true medical emergency:

sudden loss of vision
double vision
a dilated pupil or change in pupil size
swollen optic nerve
painful proptosis
headache

Does your head hurt? Any loss of vision? Double vision? You’ve sure got the dilated pupil and change in pupil size.

“Proptosis” means one eyeball is bulging outwards more than the other. This website says you can tell by looking down at the top of the seated patient’s (your) head and seeing if one cornea bulges out more than the other. So “painful proptosis” means your eye is bulging out from your head and it hurts.

Dude, you’re looking at a trip to a doctor (opthamologist), and if it was me, I’d sure consider going to the nearest emergency room.

astro · November 28, 2002, 4:59am

Sounds like what happens when the eye doctor uses drops to dilate your eyes. What were the OTC drops called? Maybe you are having a reaction to something in them.

Visine - from Pfizer website Now with Retsin!

Warnings
If you experience eye pain, changes in vision, continued redness or irritation of the eye, or if the condition worsens or persists for more than 72 hours, discontinue use and consult a physician. If you have narrow angle glaucoma, do not use this product except under the advice and supervision of a physician. When using this product, pupils may become enlarged temporarily. As with any drug, if you are pregnant or nursing a baby, seek the advice of a health professional before using this product. Overuse of this product may produce increased redness of the eye. If solution changes color or becomes cloudy, do not use. To avoid contamination, do not touch tip of container to any surface. Replace cap after using. Remove contact lenses before using this product.
PARENTS NOTE; Before using with children under 6 years of age, consult your physician. Keep this and all drugs out of the reach of children. In case of accidental ingestion, seek professional assistance or contact a Poison Control Center immediately.
Ingredients
Active Ingredient: Tetrahydrozoline hydrochloride 0.05%.
Inactive Ingredients: Benzalkonium chloride, boric acid, edetate disodium, sodium borate, sodium chloride, purified water

rexnervous · November 28, 2002, 5:18am

Thanks to both of you. Hadn’t even thought of googling, just came straight here to the World’s Knowledge Base.

Am reasonably sure that it’s the eye drops, both from the timing aspect and from the sympton aspect (I don’t really have any of the ‘stroke’ symptoms - though of course as I left work I told a colleague if I had a stroke on the way home he’d know why).

I’m pretty sure now that I’ve looked around that the product was Bausch & Lomb Opcon-A, but their site doesn’t have anything in the product warning that mentions eye dilation.

Celyn · November 28, 2002, 5:26am

You can get hellishpain etc if you are allergic to any ingredient in the ey-drops the guy gave you. Well, I experenced that from a lens cleaner frm my optician and it was dreadful. SO it maybe be brain aneurism - let’s hope not.

(Incidentally, the stuff that pained me for a day at least was papain, used as a preservtive in some solutions).

astro · November 28, 2002, 5:46am

The main active ingredient in Opcon-A, pheniramine maleate is an anithistamine which can cause significant eye dilation in sensitive individuals.

Re warnings -

Ophthalmic Drug Products for Over-the-Counter Human Use; Amendment of Final Monograph

Both the Advisory Review Panel on OTC Ophthalmic Drug Products (45 FR 30002 at 30033, May 6, 1980) and standard text books (Ref. 1) state that pupil dilation is a known pharmacologic effect of sympathomimetic drugs such as these ophthalmic vasoconstrictors. In both the combinat ion (antihistamine-vasoconstrictor) and the single ingredient (vasoconstrictor) products, the vasoconstrictor ingredient is considered the cause of the pupil dilation. The difference in ADE reports between single ingredient and combination products may be because the combination products are marketed under NDA’s, which have ADE reporting requirements. The agency stated in the proposal and concludes here that it would be beneficial and informative to consumers who use these products (single ingredient or in combation) to know that their pupils may become enlarged temporarily. Therefore, the agency is including a warning in this final rule. The comment contended that the pupil dilation warning appears to have little practical relationship to the goal of reducjng ADE reports to the agency. The comment added that the potential for pupil dilation is not serious and, thus, questioned the need to mention the event in product labeling. The comment did not offer any alternative language for the warning.

etc etc

Yeah · November 28, 2002, 1:50pm

“(Incidentally, the stuff that pained me for a day at least was papain, used as a preservtive in some solutions).”

Papain, derived from papaya leaves, is a proteolytic enzyme, i.e., it disolves proteins. It is used in some contact lens cleaning products to help break down proteinaceous deposits. It is sold in grocery stores as a meat tenderizer (e.g., Adolph’s). It is not a preservative and should never be put in the eye.

rexnervous · November 28, 2002, 3:17pm

Thanks again to all. No stroke overnight, and the pupil seems approximately normal now. We’ll see from here…weird and a bit scary that was.

I’m also swearing off eye drops.

benson · November 28, 2002, 5:07pm

If it was the iris that filled the eye, your pupil was constricted, not dilated. Sounds like something was in your contact lens, irritating the eye. Try new ones if you have them and if the problem persists, see your eye doctor right away. If it’s OK, I would still make an appointment just to make sure everything is alright.

Billy_Rubin · November 28, 2002, 5:29pm

OH MY GOD! You have your contact lenses in the WRONG PLACE!

(hehe!)

Glad it seems to be settling down. Still, see a doctor- don’t take chances with your eyes. As for your contacts, I use Unisol sterile saline solution only- it’s only salt water, and it helps flush away stuff on your contacts and does no harm to your eye. Better than eyedrops anyday.

b.