Why is one eye dilated and painful?

December 14, 2009 4:29 PM

The pupil in my left eye is much larger than the other and the eye is stinging (not badly, but definitely steady for the last few hours). How serious is this?

This eye has been a inflamed/irritated for about a month, off and on, but I just noticed the pupil difference tonight. I saw an opthamologist about a month ago, who gave me some steroid drops but found nothing else, other than my ongoing dry eye syndrome.

I took the steroid drops for about a week which seemed to work. When I tried my contacts, they seemed to irritate the eyes again, so I've been using lubricant eye drops and warm compreses since then (I may have used the steroid drops once or twice again in that period). Last night and this morning, I also tried the steroid drops 2-3 times.

Googling this symptom isn't pointing to anything specific, but some links do point to possible nerve damage or stroke risk. How worried should I be -- does this merit an ER visit, or should I just try to see my doctor in the next day or two?

posted by susanvance to Health & Fitness (15 answers total)

Best answer: You should definitely call the opthalmologist again about this. The iris may be stuck, which can happen in cases of iritis, which may have been what was getting treated with the steroid eye drops.

It's possible to unstick the iris, but only if it's done soon. It can become permanent if ignored.

Don't put this off. No joke.
posted by Chocolate Pickle at 4:35 PM on December 14, 2009 [2 favorites]

Best answer: Two separate friends of mine have had similar symptoms, and in both cases when they finally went to the ER, they were told that they were lucky they'd gotten there in time to save their vision. In your situation, I would definitely go to the ER or call the guy who gave you the eyedrops immediately. (Even if the office is closed, there may be an emergency number on their voice mail.)
posted by Blue Jello Elf at 4:37 PM on December 14, 2009

Could be iritis indeed. My own MD dismissed it and when I went to the ER the second doctor diagnosed it after the first one (an intern I guess) got a second opinion. ER and/or an opthamologist is what you need.
posted by GuyZero at 4:40 PM on December 14, 2009

Is the larger pupil contracting from bright light? If the answer is no, things are serious, get to a GP at the least.
posted by smoke at 4:49 PM on December 14, 2009

Ok, I'm really confused.

My iritis presented as soreness and my pupils being different sizes. And I took steroid eyedrops for that. But you shouldn't just randomly be going on and off steroids without a doctor's supervision. And I think your ophthalmologist should have followed up. And what did the doctor diagnose you with when you got the steroid eyedrops?

I would call the eye doctor's answering service, describe your symptoms, and ask what you should do. And then you want to ask a lot of questions about what's wrong with you. Iritis isn't the end of the world, but it often recurs, so you want to keep an eye on it. And steroid eyedrops put you at risk for some future eye problems, so you'd want to know about that, too.
posted by craichead at 4:53 PM on December 14, 2009

What Chocolate Pickle said. Happened to me a few months back. My GP gave me drops for dry eye, but finally, one night after the pain got so bad, I had an emergency appt with her, and she got me off to the opthamologist who gave me steroid drops and atropine. Uveitis. That was is. Also, apparently it can cause permanent damage if not seen to.
posted by b33j at 4:54 PM on December 14, 2009

Iritis is a kind of uveitis, btw.
posted by craichead at 5:00 PM on December 14, 2009

Response by poster: Thanks all. Just called my doctor, who said it is not iritis - the steroid drops were prescribed for contact lens irritation. He said I definitely did not need to go to the ER, recommended warm compresses tonight and to come in tomorrow morning.
posted by susanvance at 5:37 PM on December 14, 2009

Go to the ER if your pain increases overnight, certainly. Also, be careful with those steroid drops-- you need to taper off them over a period of days, instead of quitting them cold turkey. Your eye doc should instruct you (and might have, I'm just being pedantic) in how to take them and how to effectively taper off at the end of the regimen.

Not tapering steroid drops properly can give you abrupt spikes in intraocular pressure, which can damage your optic nerve and possibly cost you your sight in that eye. You don't want to mess with that.
posted by fairytale of los angeles at 5:58 PM on December 14, 2009

I was told to take the steroid drops for a week before tapering off. You may want to double-check the instructions for their use with your doctor when you go in tomorrow and be sure to tell him how you had been using them.
posted by Lynsey at 6:02 PM on December 14, 2009

My mother had uveitis a few months ago. It presented with slight swelling and blurriness. She was also told that, had she not seen her opthamologist right away, there could have been permanent damage (ie. blindness). I'm skeptical that your doctor could be sure that there's not a very serious problem without looking at your eye. But IMNAD. Please do see your yours first thing in the morning.
posted by kitcat at 6:21 PM on December 14, 2009

For what it's worth, when I developed migraines, the main symptom was pain in one eye and different sized pupils. The pain wasn't a surface irritation, though--more like a spike going through the eye and into the brain.
posted by PatoPata at 6:45 PM on December 14, 2009

Some kinds of eyedrops can cause pupil dilation. If you noticed after using the drops, there's a chance they were the cause.
posted by mmoncur at 1:59 AM on December 15, 2009

Jumped in here to suggest iritis and I see I've been beaten to the punch. In your shoes, even after speaking to the doctor, I would want to be seen in the office, have the dilation and the pressure checked, etc.

My experience with steroid eye drops (for iritis) and contacts is very negative. I would strongly consider moving to glasses for the duration of this treatment.
posted by immlass at 2:47 AM on December 15, 2009

Response by poster: Wanted to provide an update now that I've had a thorough examination:

Everything was actually normal, including the pressure and dilation, except that corneal irritation keeps reoccurring, so treatment is being upped for that. The dilation was gone when I woke up this morning, and was likely just a reaction to the drops, even though I had taken them several hours prior. They were florometholone, which the doctor said it is pretty low risk, even though I wasn't using them quite correctly (and that he'd never have given me the stronger variety without really strict supervision, as it does carry the risks mentioned above).

Thanks to all for the excellent advice, though, especially the glaringly obvious point to check if there was an after hours answering service - in my panic that really hadn't occurred to me.

The doctor also said that iritis is usually accompanied by light sensitivity and/or vision changes like blurriness, and those symptoms definitely warrant an immediate visit to the ER.
posted by susanvance at 11:07 AM on December 15, 2009