One-Sided Pupil Dilation and Its Neurological Implications

Q: One-Sided Pupil Dilation and Its Neurological Implications

Hello Student H： You mentioned that "my right eye has symptoms of mydriasis, meaning it does not respond to light at all without the use of dilating drops, while the left eye is normal. <br>This is because I had a viral infection in my right eye and underwent surgery when I was y

Headache and dizziness with unilateral pupil exhibiting mydriasis and loss of light reflex?

Hello Doctor, I started experiencing some brain fog about a week ago, along with mild dizziness and a tight sensation in my head, though it’s not very painful.
It feels like my head is being constricted by a rope, especially around my throat and sinuses, which feel very tight.
My right eye is also quite uncomfortable.
I visited an ENT specialist who examined my throat but did not find any issues, suggesting it might be related to my eye, anxiety, or post-COVID syndrome (I tested positive on January 31 and turned negative on February 6, with symptoms starting around February 9).

Today, due to swelling and pain in my right eye, I went to an ophthalmologist.
The doctor diagnosed me with dry eye syndrome or mild conjunctivitis.
The ophthalmologist performed a fundus examination, which showed no significant abnormalities, but specifically noted that my right eye exhibited signs of pupillary dilation without the use of dilating drops, meaning it does not react to light, while my left eye is normal.

I had a viral infection in my right eye as a child, underwent surgery, and have high astigmatism (750+) and amblyopia.
A few years ago, I noticed that the black part of my right eye is slightly misaligned, not centered in the pupil (the dark part of my eye is shifted inward), but previous ophthalmologists said it was not a problem and that my eye could move normally.
However, online information indicates that a loss of pupillary light response could suggest issues with the brain, particularly concerning brainstem tumors, which are quite common.
Although the ophthalmologist did not recommend a neurology consultation, I am very worried that I might have a serious condition.

Recently, my throat and sinuses have felt very tight, and taking deep breaths provides some relief.
I also often feel like my body is swaying or that my limbs are slightly trembling, with occasional muscle twitches or contractions (this issue has been intermittent; I saw a neurologist about six years ago, who conducted some electromyography and tests for hyperthyroidism and myasthenia gravis, all of which returned normal results).
I haven’t had any imaging studies done recently, but I can walk in a straight line, stand on one foot, and perform the finger-to-nose test without issues.

My vision has always been poor (less than 0.1 in both eyes without correction; my right eye only achieves 0.3 with glasses), but currently, I do not experience double vision while wearing glasses.
The ENT doctor indicated that I do not exhibit any obvious neurological symptoms, but I am still very concerned.
The loss of light response in one eye should also be considered a neurological phenomenon, right? I have been unable to eat or sleep well, and my symptoms have not improved.
I am unsure what to do… Could this just be post-COVID syndrome or autonomic nervous system dysregulation? Or do I need to undergo detailed brain examinations for early treatment? It seems that brain MRI scans are not covered by insurance… Thank you, Doctor! Wishing you peace and health.

Student H, 20~29 year old female. Ask Date: 2023/02/18

Dr. Jiang Junyi reply Neurology

Hello Student H: You mentioned that "my right eye has symptoms of mydriasis, meaning it does not respond to light at all without the use of dilating drops, while the left eye is normal.
This is because I had a viral infection in my right eye and underwent surgery when I was younger." This could indicate a dysfunction of the optic nerve or oculomotor nerve, possibly related to your previous eye condition.
Clinically, visual evoked potentials can be used for examination.
As for MRI scans, if there is clinical evidence suggesting cranial nerve or brain structural abnormalities, health insurance may cover the costs.
Post-COVID sequelae typically manifest about a month after infection, with potential related circulatory or respiratory issues that may need consideration.
Autonomic nervous system dysregulation can often present abnormal phenomena due to insufficient sleep, which can be analyzed through heart rate variability testing.
I recommend consulting a neurologist to discuss further examinations and treatment options.
Thank you for your inquiry, and feel free to discuss further.
Wishing you good health, peace, and happiness.
Dr.
Jiang Junyi, Taoyuan Medical Center, cares about you.

Reply Date: 2023/02/18

More Info

Understanding one-sided pupil dilation and its neurological implications can be quite complex, especially when accompanied by symptoms such as brain fog, dizziness, and discomfort in the eye. Your concerns are valid, and it’s important to approach this situation with a clear understanding of the potential underlying causes and the necessary steps to take.

Pupil dilation, or mydriasis, can occur for various reasons, including physiological responses to light, emotional states, and neurological conditions. In a healthy individual, both pupils should constrict in response to light. However, if one pupil is dilated and does not respond to light, it may indicate a neurological issue, particularly involving the pathways that control pupil size, which are located in the brainstem.

Given your history of right eye issues, including viral infection and surgery, it’s possible that some of your current symptoms could be related to these past conditions. However, the fact that your right pupil is not responding to light could suggest a more serious underlying issue, such as a neurological disorder. Conditions such as Horner's syndrome, third cranial nerve palsy, or even more severe issues like a brain tumor can lead to unilateral pupil dilation and should not be overlooked.

Your symptoms of brain fog, tightness in the throat and sinuses, and the feeling of your body swaying or trembling could be indicative of several things. These could range from anxiety and stress, particularly if you are experiencing post-COVID symptoms, to more serious neurological conditions. The tightness in your throat and sinuses may also suggest tension or anxiety, which can exacerbate physical symptoms.

The fact that you have experienced muscle twitching and contractions could also be related to anxiety or stress, but it’s essential to rule out any neurological conditions. Since you mentioned that you had normal results from previous neurological tests, it’s reassuring, but it’s also important to consider that symptoms can evolve over time.

Given your current symptoms and the specific issue with your right pupil, it would be prudent to seek a comprehensive neurological evaluation. While your eye doctor did not recommend further testing, your ongoing symptoms and concerns warrant a second opinion, particularly from a neurologist. They may suggest imaging studies, such as an MRI, to rule out any structural issues in the brain that could be affecting your neurological function.

In the meantime, managing your anxiety and ensuring you are taking care of your overall health is crucial. Stress and anxiety can significantly impact physical health, leading to a cycle of symptoms that can be difficult to break. Consider engaging in relaxation techniques, such as deep breathing exercises, meditation, or gentle physical activity, to help alleviate some of the tension you are experiencing.

It’s also important to maintain open communication with your healthcare providers. If you feel that your symptoms are worsening or not improving, don’t hesitate to reach out for further evaluation or treatment options. Early intervention can often lead to better outcomes, especially in neurological cases.

In conclusion, while your symptoms may be related to anxiety or post-COVID effects, the unilateral pupil dilation and other neurological symptoms should not be ignored. Seeking a thorough neurological assessment will help clarify the situation and guide you toward appropriate treatment. Your health and peace of mind are paramount, and addressing these concerns with a specialist is a vital step in ensuring your well-being.

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