This is a second in a series of posts on my odyssey with a dilated eye. I’ve tagged all the posts in the series here.
So I found myself, unexpectedly, with a right eye (a blind eye) that had completely dilated, for reasons unknown, a few months after my retina had detached. After an emotional week of wondering who would notice this freakish change in my eye, my ophthalmologist provided a ray of hope: pilocarpine hydrochloride drops, which were designed to, among other things, constrict the pupil. The nurse in the office told me, over the phone, that some people have some trouble acclimating to the pilocarpine at first. We’re going to give you the 1% dosage at first, she said.
She added: “Play around with it a little.” The instructions said the drops could be used up to 4 times a day.
The drops were ready for pickup on Friday. I went over, got them, went home, and had my wife put them in. (When you’re blind in one eye, putting your own drops in your blind eye is like hitting a dart board with the lights out.)
I can’t say much good about what happened over the next 30 minutes. My eye got red, I got a browache, and my pupil did not contract. That’s right: I got some really awesome side-effects with no benefits.
But I decided to be patient. Maybe with time I’d adjust to the drops. So we had them put in again on Friday afternoon (the packaging said up to 4 times a day). And then twice again Saturday. And then again on Sunday morning.
Less pain on Saturday, but no contracted pupil.
And then on Sunday: no contracted pupil, a lot of red, and a browache to serious that I decided I was done with the pilocarpine.
Except, it seemed to me, that the pilocarpine was not done with me.
On Monday I woke up and called the opthamologist’s office to tell them that the pilocarpine hadn’t contracted the pupil. Then, as they day progressed, my right eye grew red and puffy. Three hours into work it was so bad I got eye strain from reading anything, screen or paper, and for the first time in my career had to close my eyes for twenty minutes during downtime at work just to function.
I thought maybe it was just lingering effects from the drug, or maybe my body readjusting to coming off the medicine. I crashed into bed Monday night.
Tuesday and Wednesday went about the same as Monday: lots of eye strain, a bloodshot eye, and a lot of lost work productivity while I tried to keep things together. Worse still, Tuesday and Wednesday marked rare 12-hour workdays that involved meeting with people in the evenings, which only made things worse.
In a bad cosmic joke, no one mentioned my dilated pupil but several people asked about my red eye. I told them I had an eye infection. I didn’t know what else to tell them.
In an even worse cosmic joke, at some point during the week the brown in my eye disappeared entirely. So now I had, not just a dilated eye, but a virtual black marble where my brown eye should be.
On Wednesday morning I called the ophthalmologist’s office again. The nurse called me back. I explained in detail what was going on, she tracked down the ophthalmologist, who told me to stop taking the pilocarpine and also referred me to a specialist about a prosthetic contact for my eye.
I asked the nurse: did she express concern over my eye reaction?
No, the nurse replied.
Now, I’ve been with this ophthalmologist’s office for years. They’re not only good people, but they’re very good at what they do; they are some of the best in their field in my metropolitan area and many of them are attached to a very prestigious local university. But in that moment, I started to wonder if a combination of medical bustle and possibly miscommunication was getting in the way. Had the nurse fully explained my position to the ophthalmologist?
I decided to give it a little more time.
Thursday was a little better, but not much. I did some research and wondered if, maybe, I was having an allergic reaction to to the preservative in the pilocarpine. I don’t have much in the way of allergies, but I had had a reaction to a subdermal TB test years before, so I suppose it was possible. I came home after work, rested, took some Advil and some lubricating eye drops, and went to bed, knowing that, because of my two 12-hour days, I had Friday off.
I went to bed about 10 pm Thursday night. I woke up with pain around my eye at midnight, 2 am, 3 am, and 4 am. It was the first time my sleep had been affected since any of this began, and that scared me. At 4 am I took more Advil and propped a second pillow under my head, and slept until 7 am.
At 7 am I got up and decided I was going to call the ophthalmologist’s office and leave a voice mail. Only this time I was not going to ask them what I should do. I was going to tell them that I needed to see someone … if not the lead ophthalmologist, then one of the optometrists who also staffed the office. The very last thing I wanted was to go into the weekend not knowing what was going on with me.
I left a detailed message at 7:15 am. At 7:45 — 15 minutes before the office opened — I got a call back from the same nurse I’d spoken with earlier in the week. She said the ophthalmologist was in another hospital that morning, but asked if I wanted to see one of the optometrists at 11 am.
I waited only as long as was socially necessary before replying, “Yes.”