I was caught completely by surprise yesterday when I learned that my pupil is permanently blown. All this time, I have been so focused on the damage to my eyelids and my detached retina that I never really looked at my eye itself in good light. Apparently, the blunt trauma from my mesquite missile also ruptured my iris, leaving barely any iris visible at the perimeter and no functioning muscle. This means that my pupil has no way of constricting, so it will always let in too much light.
None of my doctors has ever mentioned this aspect of my injury to me. Dr. Harris didn’t even know; at every visit, one of her techs has dilated my eye before she saw me. She saw me on Friday without dilation to assess the possible options for attaching my lens during my upcoming surgery (one option might have been suturing it to my iris) and realized that I never needed dilation: my pupil is wide open. Dr. Levine apparently knew of this condition, because he wasn’t surprised when I called him with the information, but he has never talked about it with me; I guess it was low on the list of damage to be dealt with. I have no idea whether Dr. Polonski knows; I think his assistant dilates me too, but I may be mistaken. (Karen had noticed my huge pupil when she was putting drops in but didn’t realize the significance and never mentioned it.) I will see Dr. Levine at the end of the week to discuss my iris and any implications for the surgery. Online research indicates that the only surgical options for actual repair of the iris (prosthetic iris implants) are still experimental. I am guessing that I will end up wearing a contact lens with an iris printed on it and a fixed clear pupil to limit the amount of light that can enter.
Up to now, my open pupil has not been a problem for two reasons: first, because my eyelid opens so little, the pupil is mostly covered; second, the silicone oil dims the light that does enter. I do notice some glare in that eye when I am sitting next to a lamp. Once the oil is removed, that will likely be exacerbated, and when I am outside, I will have to start wearing sunglasses regularly.
I am still adjusting to the information. The surprise of it so long after my accident has temporarily thrown me for a loop, but knowledge is power, and the more I learn about the condition (apparently known as traumatic mydriasis) and my options, the easier it is to accept it and proceed.