Pilocarpine drops or Suture the pupil

Posted , 5 users are following.

I have larger than normal pupils (6-7 mm) in one eye. Because of this, my vision is not as sharp as it should be. For diagnostic and informative reasons, my doctor prescribed me low dose oral Pilocarpine 1%, twice a day to see if they would induce miosis (shrink/constrict the pupil). If it does, then he suggested two options: (1) Continue taking Pilocarpine once or twice a day, indefinitely or (2) Explore long term option of suturing the pupil to a smaller size.

I've read that Pilocarpine does not have serious side effects. Low doses are even prescribed by pediatric doctors to children two and younger. My doctor said higher concentration (like 4%) of it induces brow ache but lower doses should not/do not. The first day I started Pilocarpine, I experienced mild brow ache and heavy eyelid. Second day was less. Third day onwards, none. It's been seven days today.

I'm edgy with the thought of suturing the pupil to constrict it. After all, it is a procedure and carries a certain amount of risk, both during and afterwards. For one, pupil dilation will be restricted afterwards.

I would like to ask the community here, if patients have had good or bad experiences with Pilocarpine drops. How long have you been using it and has it improved your overall vision to the point that you are happy using the drops indefinitely?

Also, has anyone had a pupil constriction procedure with sutures? Are there risks associated with it? Are you happy with your visual outcome after the procedure?

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  • Posted

    I am not answering your question directly, but my suggestion is to leave well enough alone.

    When your eyes are in good light, your pupil automatically becomes smaller any way. That is why one can usually see better in good light than in low light.

    If you reduce your pupil size, you should expect worse night vision in low light than you have right now.

    Have you had a cataract surgery or do you expect one in the near future? Any way, please know that cataract surgeries are harder with smaller pupil and that a cataract surgery itself can reduce the pupil size.

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    • Posted

      My intuition was exactly what you said, and what Salty0 echoed: to leave well enough alone. I've had cataract surgery in both eyes in the last two months. And they have gone extremely well. My doctor said that a smaller pupil would give me a "better" dept of field and improve my overall vision, but not that my current vision is bad. Thank you for your replies and apologies for my very late reply.

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  • Posted

    I agree with at201, surgery should always be your last option when all other less invasive options fail. Review the comments and you will see surgery is not always the best option and often has irreversible effects.
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  • Posted

    Well it's a live and learn world and as I've learned much to my chagrin, if you seek out the advice of a surgeon he or she will usually always want to operate, because that's what they do, kind of like a hammer looking for a nail, it's the only tool in their tool box. If you want an unbiased opinion go to a University teaching hospital and seeks the opinion of a non surgical opthamologist so that you have both options spelled out. I learned that lesson the hard way with my spine 19 years ago but time clouds your memories and I didn't bring that lesson to bear on this issue of cataract surgery since it seemed so " run of the mill" nothing invasive is simple or run the mill and none of it should ever be taken lightly. I'm paying the price now for not doing my research, hopefully I will recover my vision because right now it's screwed but I hang my hope on the fact that they tell me it can be resolved either naturally over time with the healing process or by more surgery. What I didn't know about this surgery and the lenses ( before the surgery) could fill a book, my bad! I will never again have that laissez-faire attitude towards any surgery as I unfortunately adopted with this type of surgery. Good luck

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