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Clayton from Jacksonville, United States of America, asks:
I had herpes simplex in my right eye for many years. Over time the scarring covered the cornea and I could no longer see. In December of 2014 I had a corneal transplant. There were 2 issues that came from the surgery. First, my pupil was completely dilated. The surgeon put me on Pilocarpine saying it may help. It did go down, but is still 3 times the size of the other. Second, my upper eyelid does not open as far as the eyelid that was not operated on. The eyelid issue and the fixed dilated eye catches everyone's attention. My questions are: what caused these and secondly, what can be done to correct them? Two years later the same surgeon removed a cataract from the same eye. He told me he would try something to maybe help with the pupil. I was awake at the end and he was not aware. He told his team he was going to try squeezing the eye to see if the pupil will retract some. I watched him do it. There was no change.
Dear Clayton, thank you for your query about your pupil and eyelid after corneal transplant surgery. The dilated pupil and the droopy eyelid are recognized complications that can occur following any intraocular surgery, although they are not common. How these come about is unclear.
With the pupil, a theory is that surgery causes stress to the pupillary muscles or its nerves, resulting in the pupil being permanently dilated. Pilocarpine eye drops is one treatment option. The most effective treatment option is to have an operation called pupilloplasty, where the enlarged pupil is stitched in a way to make it smaller. However, there is a risk that this operation could jeopardize your corneal transplant.
With the eyelid, a theory is that the clip used to keep your eyelids open during surgery somehow weakens the upper eyelid muscle, causing the eyelid to droop. The only treatment is to perform ptosis surgery, whereby the upper eyelid muscle is strengthened with stitches. This operation does not pose any risk to your corneal transplant. However, there is a small risk of over-correction - your eyelid position becomes too elevated and you are not able to close your eye completely.
Paul from Hickory, United States of America, asks:
After having cataract surgery that went bad, my eye will start watering, running down my face. This happens quite frequently. Is there anything I can do for this? Ophthalmologist says there is still swelling in my eye after 2 to 3 years!
Dear Paul, thank you for your query. Sorry to hear that your cataract surgery did not go as well as it could. Unfortunately the eye can sometimes be persistently inflamed after complicated cataract surgery - this can cause your eye to water frequently. A course of anti-inflammatory eye drops may help. Unfortunately without knowing what happened during surgery, it is difficult to advise of any specific solutions to your problem.
Izhar from Hod Hasharon, Israel, asks:
Are fused silica suitable for intraocular lens implants? Will the silica withstand hydrolysis by body fluids?
Dear Izhar, thank you for your query. I think this depends on the composition of the fused silica. In general, acrylic intraocular lens implants are stable within the eye. Sorry, this is not my area of expertise - perhaps the lens manufacturing companies may be able to assist you further.
Betty from Tucson, United States of America, asks:
I started having occasional throbbing pain in my eye starting about 2 months after my cataract surgery. What could this be?
Dear Betty, thank you for your query. I think your symptoms of throbbing after cataract surgery could be due to elevated eye pressure or persistent inflammation. Might be worthwhile to consult your eye specialist about this issue, especially if it doesn't settle. Good luck!
Michelle from Bellmawr, United States of America, asks:
It's been 2 years that started with a severe corneal ulcer. Downhill all the way. At first they suspected a super infection. This was never proven, but I had severe inflammation that could not be controlled for close to a year. I've had 3 implants and 2 emergency surgeries. Scarring, retinal detachment, cataract, glaucoma and corneal perforation. Last surgery was for the perforation - another implant, took out a large cataract, and put a lens in. Within one week, they are shocked. Said it looks like something they would see a year from now, not days after surgery. I'm in pain from all the effects of this. The large white spot on my eye that really hurts, is getting very hard, like plastic, and then settles down but seems to turn into discharge. I'm not sure if this is good and healing, or if I should rush right back. Any info is appreciated. And I should add these are wonderful caring doctors. They are dumbfounded. Thank you.
Dear Michelle, thank you for your query. It sounds like you have had a tough time with your eye, having had to undergo multiple operations, including cataract extraction, corneal transplant, and glaucoma filtering surgery. With difficult corneal inflammation, it is important to exclude fungal infection, herpetic infection, and autoimmune corneal melt. I am sure that the team of eye specialists looking after you (which should include a cornea specialist) will have already looked into this for you. If not, please ask them to perform the necessary blood and ocular tests. What you describe could be a sign of early perforation. My advice is to go back to see your eye specialist in the next day or so. Good luck!
David from Ennis, United States of America, asks:
After having cataract surgery, I was told I would have to wear glasses for reading only. Seven months later, the proper glasses, which were to be issued from the Doctor's In-Office glasses center, had not been issued. The reason given each of the three times I called for an appointment was the same: "The eye glass specialist would call me to make an appointment." Meanwhile, I have experienced watery eyes, a burning while reading and vision impairment while not wearing glasses. I rescheduled an appointment, by means of my insurance company. At this appointment my vision was rechecked and the prescription required now is in fact different than the first prescription. I was told this was because of some debris behind the implant and that I would have to have a second surgery. My question is: "How would debris get in behind the implant?"
Dear David, thank you for your query. If your cataract surgery went well, then it is likely that the debris referred to is posterior capsular opacification. This can easily be treated with a 5-minute laser procedure (called laser capsulotomy) in the doctor's office. As the glasses prescription can change yet again after laser, you may need to wait a few more weeks before making a new pair of prescription spectacles.
Barbara from Sacramento, United States of America, asks:
Double vision since the day after cataract surgery. Little improvement with prisms in eyeglasses. It is intermittent with or without glasses. If nerve damage, will there be hope of reversal of double vision?
Brian replies: January 2017
Russell from Brea, United States of America, asks: Brian replies: Disclaimer: Replies to your questions are only general in nature, and in no way are to be considered as replacement for a proper ophthalmology consultation and examination. If you require a more specific evaluation, please consult your ophthalmologist for a full eye examination.
Dear Barbara, thank you for your query. When you experience binocular double vision, this is usually due to misalignment of your ocular muscles. This misalignment can occur due to a problem with the ocular muscles themselves or a problem with the nerves that supply these muscles. Monocular double vision, on the other hand, is likely to be due to an ocular problem such as cataract or posterior capsular opacification.
The fact that your double vision is intermittent suggests that it is binocular in nature. It is difficult to comment on whether the double vision will reverse without actually examining your eyes. As treatment may involve either prisms alone or surgery or a combination of both, it is definitely worthwhile for you to consult with an ophthalmologist who has a special interest in ocular motility disorders.
I went to the eye doctor last week and I have 20/400 in the right eye. Does that mean I am considered legally blind? My other eye is 20/25.
Dear Russell, thank you for your query. Your right eye certainly has poor vision. However, to qualify as being legally blind, both eyes must have poor vision. Because your left eye is still seeing very well, you are therefore not considered to be legally blind.
Russell from Brea, United States of America, asks:
Disclaimer: Replies to your questions are only general in nature, and in no way are to be considered as replacement for a proper ophthalmology consultation and examination. If you require a more specific evaluation, please consult your ophthalmologist for a full eye examination.