One-Sided Pupil Dilation and Headache Symptoms

Q: One-Sided Pupil Dilation and Headache Symptoms

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 painful—more like a feeling of being constricted by a rope, especially around my throat and sinuses.
My right eye also feels uncomfortable.
I visited an ENT specialist who examined my throat but didn’t 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 mentioned it could be dry eye syndrome or mild conjunctivitis.
The ophthalmologist performed a fundus examination, which showed no significant abnormalities, but specifically noted that my right eye exhibits a pupillary response issue—essentially, it does not react to light without the use of a dilating agent, while my left eye is normal.

As a child, I had a viral infection in my right eye that required surgery, resulting in high astigmatism (over -7.50) and amblyopia.
In recent years, I also noticed that the black part of my right eye is slightly misaligned, not centered in the pupil (the dark part of the eye is shifted inward), but previous ophthalmologists assured me there was no 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's nerves, particularly concerning brainstem tumors, among other serious conditions.
Although the ophthalmologist did not recommend a neurology consultation, I am very worried that I might have a serious illness.

Recently, I have felt tightness in my throat and sinuses, which is somewhat relieved by deep breaths.
I often feel like my body is swaying or that my limbs are slightly trembling, and I frequently experience muscle twitches or contractions (this issue has fluctuated over the past six years; I saw a neurologist then who performed some electromyography and tests for hyperthyroidism and myasthenia gravis, all of which came back normal).
I haven’t had any imaging studies 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; with glasses, my right eye is only 0.3), but currently, I do not experience double vision while wearing glasses.
The ENT specialist indicated that I do not exhibit any obvious neurological symptoms, but I remain 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 don’t know 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 young." 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 (Magnetic Resonance Imaging), if there is clinical evidence suggesting cranial nerve involvement or abnormalities in brain structure, it may be covered by health insurance.
Post-COVID sequelae typically present with related circulatory or respiratory issues about a month after infection, which should also be considered.
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 and peace.
Dr.
Jiang Junyi, Taoyuan Medical Center, cares about you.

Reply Date: 2023/02/18

More Info

Your symptoms of one-sided pupil dilation, headache, and feelings of brain fog are understandably concerning, especially given your recent history of COVID-19 and the various eye issues you've experienced. Let's break down your symptoms and the potential underlying causes.

Firstly, the sensation of tightness in your head, particularly around the throat and sinuses, could be indicative of tension-type headaches or sinus-related issues. Tension headaches often present with a feeling of pressure or tightness, and they can be exacerbated by stress, anxiety, or poor posture. Given your mention of anxiety and the recent COVID-19 infection, it's possible that these factors are contributing to your symptoms.

The right eye's discomfort and the noted lack of reaction to light (pupil dilation) are particularly noteworthy. Pupil response is controlled by the autonomic nervous system, and a lack of reaction can sometimes indicate neurological issues. However, since you have a history of eye problems, including viral infections and strabismus (misalignment of the eyes), it’s essential to consider that your eye condition may be influencing your current symptoms. Dry eye syndrome and mild conjunctivitis can cause discomfort and may also lead to secondary symptoms like headaches.

Your concern about potential neurological issues, such as brainstem tumors, is valid but should be contextualized. While abnormal pupil reactions can indicate serious conditions, they can also result from less severe issues, especially in individuals with pre-existing eye conditions. The fact that your eye doctor did not recommend further neurological evaluation suggests that they did not find immediate cause for alarm. However, your ongoing symptoms and anxiety warrant further investigation.

Given the complexity of your symptoms, including muscle twitching and the sensation of your body swaying, it may be beneficial to consult a neurologist for a comprehensive evaluation. This could include imaging studies like an MRI, which, while not covered by insurance, may provide peace of mind and rule out any serious conditions.
Additionally, your symptoms could be related to post-viral syndromes following COVID-19, which can manifest as fatigue, cognitive issues, and neurological symptoms. Autonomic nervous system dysregulation is also a possibility, which can lead to symptoms like dizziness, lightheadedness, and muscle twitching.

In the meantime, consider implementing stress-reducing techniques such as mindfulness, yoga, or gentle exercise, which may help alleviate some of your symptoms. Staying hydrated and maintaining a balanced diet can also support your overall health.

In summary, while your symptoms are concerning, they may not necessarily indicate a severe neurological condition. However, given the complexity and persistence of your symptoms, a thorough evaluation by a neurologist is advisable. This will help clarify the underlying causes and guide appropriate treatment. Remember to prioritize your mental health during this time, as anxiety can exacerbate physical symptoms. Wishing you a speedy recovery and improved health.

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