Unilateral Pupil Dilation and Its Possible Connections

Q: Unilateral Pupil Dilation and Its Possible Connections

Hello Ms. <br>Chen： You mentioned that "the right pupil had no light reflex and remained dilated. <br>At that time, I didn't know the cause and didn't see a doctor. <br>After about a month, the right pupil returned to normal, but afterwards, there was occasionally a small amount

Unilateral pupil dilation?

Hello, doctor.
Two years ago, while I was abroad, I suspect that I sustained a blunt force injury to the back of my head.
At that time, my right pupil did not respond to light and remained dilated.
Since I was unaware of the cause, I did not seek medical attention.
After about a month, my right pupil returned to normal.
However, I have since experienced occasional ear discharge (not water, the fluid is clear and odorless) and occasional tinnitus.
I would like to know if these two issues are related.
If I were to see a doctor, should I consult a neurologist or an otolaryngologist?

Chen Pei, 30~39 year old female. Ask Date: 2022/03/17

Dr. Jiang Junyi reply Neurology

Hello Ms.
Chen: You mentioned that "the right pupil had no light reflex and remained dilated.
At that time, I didn't know the cause and didn't see a doctor.
After about a month, the right pupil returned to normal, but afterwards, there was occasionally a small amount of clear, non-odorous fluid leaking from my ear, along with occasional tinnitus." It may be necessary to consider a possible skull base injury.
I recommend that you first consult an otolaryngologist to determine if it is cerebrospinal fluid.
If so, you may need to see a neurosurgeon for repair.
Thank you for your inquiry, and feel free to discuss further.
Wishing you good health, peace, and happiness.
Dr.
Jiang Junyi from Taoyuan Medical Center cares about you.

Reply Date: 2022/03/17

More Info

Unilateral pupil dilation, also known as mydriasis, can be a concerning symptom, especially when it follows a head injury. In your case, the history of blunt trauma to the back of the head, resulting in an initially dilated right pupil that later returned to normal, suggests that there may have been a transient disruption in the neural pathways that control pupil size. The autonomic nervous system regulates pupil size, and any injury to the brain or its pathways can lead to changes in pupil response.

The fact that your right pupil was dilated and unresponsive to light for a period of time indicates that there may have been some temporary damage to the oculomotor nerve (cranial nerve III), which is responsible for constricting the pupil. This could have been due to the trauma you experienced. The subsequent normalization of the pupil size is a positive sign, suggesting that any initial damage may have resolved.

However, the ongoing symptoms you describe, such as occasional ear discharge and tinnitus (ear ringing), could potentially be related to the initial injury. The ear and the brain are closely interconnected, and trauma to the head can sometimes lead to issues in the ear, including fluid accumulation or changes in pressure. The clear, odorless fluid you mention could be indicative of several conditions, including a possible cerebrospinal fluid (CSF) leak, especially if it is coming from the ear. This is a serious condition that requires immediate medical attention.

Given your symptoms, it is advisable to consult a healthcare professional. In this case, you may want to start with an ear, nose, and throat (ENT) specialist, as they can evaluate your ear symptoms and determine if there is any connection to your previous head injury. They may perform a physical examination and possibly imaging studies to assess the condition of your ear and surrounding structures. If they suspect that your symptoms are related to a neurological issue, they may refer you to a neurologist for further evaluation.

In summary, while your initial pupil dilation may have resolved, the ongoing ear symptoms warrant further investigation. It is essential to seek medical advice to rule out any serious underlying conditions, especially given your history of head trauma. Early intervention can be crucial in preventing potential complications.

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