Patients frequently ask me how long their pupils will remain dilated after the eye exam. Eye Doctors use different drops,different strengths, and different dosages when dilating your pupils. If you are having light flashes or symptoms that could indicated retina problems two different drops may be used in higher concentration and several doses. A routine exam may only require less dilation and milder drops.
Eye color effects the duration of dilation. Since brown pigment in the iris is essentially the only eye pigment, blue eyes lack significant color and gain their blue shade from light reflecting in the iris. Pigment binds the dilating drops and require higher doses but blue eyes react faster and more to dilation drops.
Different drops are often used for children’s eye exams and occasionally for adults that have inflammation in the eye from contact lens injuries, eye trauma, or autoimmune diseases and they may keep eye dilated for several days.
Finally, there are individuals with idiosyncratic reactions to the prescription eyedrops used to dilate your eyes. Basically, that means the optometrist is an idiot and has no idea why one out of hundreds of eyes are extremely sensitive to dilation drops and stay dilated for 24 hours or more. (The meaning of idiosyncratic is a well kept secret by all types of Doctors so please don’t reveal me as the source of explanation). If you have this type of reaction you can try and request a little known secret we use-simply diluting the drop!
The final answer is your eyes will usually stay dilated for several hours but it could be up to several days. Good luck and remember, after the first time you will probably have a fairly good idea of what to expect in the future.
Hi Allegra,
After a week and with your pupils being back to normal I would think your symptoms are probably not related to the dilation. Are you still experiencing any flashes? They should stop when the vitreous is completely detached. Sometimes you can have a little swelling in the retina that can make you more light sensitive. On occasion this can lead to an epiretinal membrane. These can be hard to see at times. OCT (optical coherence tomography) is new scanning technology that can show swelling on a microscopic level. It is fast and painless but you might have to check around to find someone who has an OCT instrument in your area. Just the presence of floaters can drive you half crazy and make you more aware of light. Fortunately it normally gets better with time. Anytime you are experiencing flashes they need to be followed up every few weeks until they go away. Eyes are at risk for having retinal detachments and retinal tears when there is traction (or an attachment of the vitreous that is stronger than normal). Once the vitreous is fully detached it is no longer considered an elevated risk. It sounds like you are OM and should follow up in a week. You could always have a second opinion with a retinal specialist, but it would probably take a month to get in for an appointment. Keep in mind that things can change rapidly
when there is vitreous traction, and any sudden increase in floaters or a screen like veil or shadow that appears in your vision could be a retinal detachment. Retinal detachments needs immediate treatment to preserve vision. The retina can only survive a short period without a functional blood supply, and sometimes a few days causes irreparable harm.
Best Wishes
Hi. My six year old son had a routine eye exam done for the first time yesterday, for which his eyes were dilated using three different kinds of drops. His eyes were perfect, according to the doc. Within minutes of getting the drops, he complained that his jaw hurt a little and he had a bad taste in his mouth. After, he was mildly nauseas and dizzy (everything shaking a little). Then, seven hours later (middle of night), he began vomiting and cramping, which lasted all night. He has no other symptoms of illness, no fever, etc. I have read that vomiting and nausea are possible side effects of the drops. Could this be the case for him? I am curious about the time frame–if it is a reaction, whether the vomiting would have started sooner, or how long it might last, etc. My son is, btw, a somewhat allergic and sensitive child (food and seasonal allergies).
Hi Mom,
Eye drops can drain out the tiny tear puncta, or openings on the eye lid margins. From their they drain into the nasal sinuses and down the back of the throat-not the best tasting thing in the world. Jaw pain can be signs of a heart attack but probably not in this case. Who can interpret the mind of a 6 year old?
Allergic reactions can be immediate and/or delayed. Delayed onset reactions can occur with a few hours to 24 hours after the exposure and usually stop within 24 hours. It does sound like an allergic reaction to the drops, but when my children were 6 they did tend to throw up at random, inconvenient times of their choosing.
I do hear people complain about being a little dizzy after dilation drops fairly often. In the past I presumed it was more of a psychological symptom but these days I believe it is probably frequently a side effect (not an allergy) form the drops.
I would be cautious about dilation drops in the future. Find out which drops were used and try avoiding the use of cyclopentolate, homatropine, and phenylephrine next time around. Tropicamide alone might be a better option. You might want to discuss giving him a small dose of benadryl before his next visit just in case. Watch his diet also. Heavier use of antibiotics and more junk food may help predispose kids to future problems with allergies and asthma.
Best Wishes
The nausea and vomiting could be
I took my 4 yr old son to an eye dr to have his vision checked. We were there for over 4 hours. After they dialated his eyes he fell asleep and slept for an hour before the nurses came back in. The dr diagnosed him with hyperopia and gave him a prescription for glasses. When I took the prescription to be filled, the lady there commented on how strong they were compared to his vision which I was told was 20/30 in one eye and 20/40 in the other. He was prescribed a + 3 to be worn at all times. We got his glasses and took them home. I knew it would take a few days for him to adjust but he was complaining with his head hurting and was tripping over everything over a week later. I took him to a different eye dr for a second opinion, and was told that the prescription was way too strong for him, he only needed a +1.50. The new glasses are much better and he seems to have no problem with them at all. Do you think when he fell asleep that it affected the results of the first eye exam, causing the eye dr to prescribe him something too strong?
I understand that some patients remain dilated longer than others, but how long should a patient wait before revisiting the doctor? And what if any dangers are there to extended dilation?
Hi Barrett,
I would advise letting the eye doctors office know if you are still dilated the next day. I will not usually see the patient at that point as long as there are no other symptoms, but I do want to know. The only real risk is angle closure glaucoma in people who are predisposed with abnormal iris structures. This is a one 250,000 people so it is a fairly low risk. It is the dilation itself and not so much the duration of time that elevates the risk. The problem occurs at mid dilation where the pupil gets stuck. That may make it seem like someone is staying dilated for a very long time when in fact they have angle closure glaucoma. Usually people with this condition are very sick with nausea, headaches, and upset stomachs (not a little but a lot). The other risk from extended dilation is an increase in UV and visible blue light exposure. Without proper sunwear protection this can result in acute injury (snow blindness) and contribute to long term risks for macular degeneration and cataracts. We always have people wear the wonderful looking little roll up sunwear when they are outside until their eyes return to normal. Unless you have high quality dark sunglasses, you should rely on these in addition to your normal sunglasses or to replace them.
Best Wishes
I took my 4 yr old son to an eye dr to have his vision checked. We were there for over 4 hours. After they dialated his eyes he fell asleep and slept for an hour before the nurses came back in. The dr diagnosed him with hyperopia and gave him a prescription for glasses. When I took the prescription to be filled, the lady there commented on how strong they were compared to his vision which I was told was 20/30 in one eye and 20/40 in the other. He was prescribed a + 3 to be worn at all times. We got his glasses and took them home. I knew it would take a few days for him to adjust but he was complaining with his head hurting and was tripping over everything over a week later. I took him to a different eye dr for a second opinion, and was told that the prescription was way too strong for him, he only needed a +1.50. The new glasses are much better and he seems to have no problem with them at all. Do you think when he fell asleep that it affected the results of the first eye exam, causing the eye dr to prescribe him something too strong?
Hi Tabetha,
I doubt the snooze had any effect on the prescription other than giving the drops a little more time to work. It can be a little bit of a dilemma with a 4 year old to prescribe lenses they will wear. Depending on the type of drops used, they will alter the amount of prescription shown in the readings. Four year olds have such a large focusing capacity that they can over compensate and give artificially low readings. Once the drops kick in and eliminate a large amount of this focusing, a more true reading can be seen.
Unfortunately, just because its their prescription that doesn’t mean they can tolerate. It is somewhat similar to holding your fist clenched all day then trying to open it at the end of the day-you can’t let go of the tension all at once. My guess would be that is your sons case. If he is tested with adequate drops he probably shows more prescription than without. The end result is starting with the lower prescription should allow him time to adjust and it can probably be made stronger next year. The 20/30 and 20/40 are not out of line for a +3, kids have a lot of ability to compensate and clear vision up when they are farsighted. So both docs are right in a way, but the prescription you can use is always the best one!
Best Wishes
Hi Tabetha,
The only effect I would see from falling asleep would be giving the eye drops a longer time to fully work. This could give a stronger reading for the eyeglass prescription but normally it would be needed. The 20/30 and 20/40 are not out of align for a +3.00 correction in a 4 year old. Kids at this age have such a great capacity to compensate for farsightedness that they often see 20/20. It can still create a lot of eyestrain in constantly using effort to clear things up.
I’m glad you took him for a second opinion. It does not matter what we think is the right prescription, you want eye glasses your son will wear. In my experience, people who are not reasonably comfortable wearing their glasses in the first few weeks will end up leaving them in a drawer somewhere and using an older pair or nothing at all. SO even though the +3.00 may be correct, it it usually better to have them wear the most they will tolerate and make it a little stronger next year. I hope this helps.
Best Wishes
I took my 8yr old to opthomologist , the tech instilled 5drops in each eye, 20 min later she came back his pupils were dilated to 6mm and wanted to instill more drops, a month prior my other 8yr old son was seen at the same office and also had eyes dilated with 2drops only . Would more drops dilate the eyes faster? Could this harm his eyes or anything else?
Hi Libby,
Sometimes it does take multiple drops over a period of time to adequately dilate the eyes but normally I see that in the elderly and patient who have diabetes. Using multiple drops of the same medication at the same time won’t really help dilate the eyes faster, they will just rinse out. Frequently three drops are used each time. The first drop numbs the eyes a little and allows the dilating drops to enter into the eyes easier. The second drop inhibits the muscle that constricts the iris, and the third drop stimulates the muscle that dilates the iris. Three different drops in this type of manner will dilate the eyes faster. There really should not be any harm from multiple drops.
Best Wishes
Hi, I live in China. My four year old daughter is seeing an optometrist this week. We’ve been asked to put drops in her eyes twice a day, for three days before the appointment. Is this normal practice in the west? Elin said this morning that things aren’t so clear, I’m worried what will happen if I keep putting the drops in.
Thank you so so much, my wife and I are very worried about this.
Hi Gareth,
I have never used this process but it is often used in younger children in the west. Normally it is used in young children who have eyes that tend to turn in. There are many cases of “accommodative esotropia”, or eyes that turn in caused by large amounts of farsightedness that has not been corrected by glasses. Using atropine eye drops for several days prior to the exam will eliminate any focusing your daughter does to compensate for farsightedness. Whatever eye turn amount that remains is considered to be the real eye turn and not artificially created by focusing. Sometimes that allows you to avoid unnecessary surgery. The side effect of this type of drop is the loss of focusing for near and in the case of uncorrected farsightedness the will also lose the capacity to compensate for this ( by focusing) for distance. Vision can end up blurry for distance and near in the meantime. I don’t think you have anything to worry about, it should go away in a few days. Let the eye doctors office know.
Best Wishes
One day after eye exam with diolation my eyes is still blurry and dialated
My daughter (16 years old) had her eyes dilated 4-5 years ago and I noticed over the course of the day that her left eye returned to normal several hours before her right eye did. It concerned me at the time but I thought that maybe it was normal and I was being overconcerned so I never asked about it. At the beginning of 2011 she had some medical problems appear suddenly (seizure like activity) and at that time we found out that she has a lesion on her right occipital lobe (near the parietoccipital sulcus) that also involves the leptomengial network. I am told that it is believed to be Cortical Dysplasia. Could the difference in how her eyes returned to normal after dilation have anything to do with this lesion?
Hi Frank,
It is a pain but sometimes it happens. You should be back to normal by now.
Best Wishes
Hi Tracey,
First off I am out of my league on this question, it falls more into the realm of neuro-ophthalmogy. Pressure from the leptomeninges could potentially cause a brainstem herniation that creates pupil dilation. I suppose if it was a mild, transient condition one eye could appear to stay dilated longer. It would be on the same side. Frequently eyes return to normal at different rates after routine dilation. It is almost impossible to get the same dosage in each eye since people blink at different times, drops partially bounce out of the eye, the second eye is probably tearing more by the time it gets a drop, and drops don’t come out of the bottle in the exact same amount. After drops reach the eye, the eyes can react differently, and even the tear film can dilute or neutralize the drops differently between the two eyes. I don’t think there is any way to know in your daughters case, but probably it was just a quirk the way eyes normally react to dilating drops. If it happens again the same way, same side it might be a different answer.
Best Wishes To You and Your Daughter
I got my eyes dilated on Wednesday and now it’s Sunday and nothing has change. I went in because of I have herpes simplex on my eyelid. I have a horrible headache from light or just trying to do things up close… Is my vision suppose to take this long to get back to normal ? I’m pretty scared they won’t. What should I do. one Dr told me to come back in the other Dr told me it should wear off …. I don’t know if I should go to another Dr or wait … I just started putting eye drops in today. What should I do !
Hi Latesha,
Let your Doctor know. Usually it is just a stronger reaction to the drops but eyes to develop angle closure glaucoma when dilated in about 1 of every 250,000 dilations. Actually they were already developing it in those rare cases but it makes it evident and prevents blindness by encouraging early treatment.You should be in the 249,999 normal group but let your doctor make that decision.
Best Wishes
I have A-fib and take Coumadin to minimize the chance of a blood clot. I use an at home device (CoaguChek) to measure my INR. After a recent eye exam, which included dilation, my INR went to 4.8. My historically normal range is 2.6 =+/- 0.4. It returned to normal 2 days later after taking no Coumadin and is stable after 2 more dayys of my usual regimen of 7.5 mg/day. Is this a known side effect
of medications used for dilation?
Thanks
My 4 yr old has been given Atropine Sulphate ointment three days prior to his vision appointment, he is being treated for his lazy eye . It has been over 2 weeks now but the pupils still look dilated.
The doctor said they will come back to normal in 24 hours but after 5 days we noticed they were still enlarged , upon calling her she said for some kids it can take 2 weeks but we are past 2 weeks but still they look the same. Is this normal?
She also suggested to use the drops which will shrink the pupil size if we are concerned but i am not sure what is the right thing to do.
PLEASE , PLEASE Advice.
Hi Mike,
There are no interactions with any of the commonly used drugs for eye dilation that I am aware of. There are always idiosyncratic reactions- which means the Doc is an idiot! Idiosyncratic reactions are those rare ones that are unique to one person and we lack an explanation for-thus a nice sounding word to conceal that fact. You probably need to be dilated every year with your health history but I would check the numbers closely next time and talk to the prescribing doctor and your eye doctor in advance. If it happens again you might want to consider replacing the dilation with digital pictures- Its not as good but
better than the risks of tanking your numbers.
Best Wishes
Hi Shanti,
Atropine can normally last up to two weeks. Some people will stay dilated a little bit longer than that. It is also possible to re-dilate your eyes by rubbing some of the ointment onto a piece of clothing or other object then touching this prior to rubbing the eyes again. Kids can do amazing things! I would not be too concerned at this point if the dilation has started to reduce somewhat. Keep in touch with your eye doctor but give it another week. I would not be in a hurry to use reversal drops but there is little harm (other than brief redness and discomfort) in trying them. The only possible concern is angle closure glaucoma but that tends to make people very sick with nausea and vomiting and is very rare. Give it a little more time and make sure he (or she) wears sunglasses when he is outside.
Best Wishes