Large Pupils – Causes, Treatment & Prevention

Large pupils are usually a reaction of the eye to low levels of ambient light. This allows the eye to control how much light falls on the retina and ultimately how well the environment is seen. If large pupils are not a response to low ambient light, or if the pupils are of different sizes, this can be a symptom of a variety of disorders, diseases or conditions.

Large pupils can result from a head injury, tumor , neurological problems, poisoning , death, or use of certain recreational or therapeutic drugs. Large pupils that no longer react to light and remain completely rigid are an indication that death has occurred.

The most well-known narcotic causes of large pupils are cannabis, LSD, amphetamine and cocaine. If a serious head injury or tumor is suspected, an MRI or CT scan is often done.

causes

If the dilated pupils are not a reaction to light, medication (e.g. eye drops, antihistamines, atropine, pseudoephedrine) can also dilate the pupils significantly. In addition, taking drugs (e.g. amphetamines, cocaine, pseudoephedrine, LSD, cannabis, methamphetamines) often leads to dilation of the pupils.On the other hand, opiates (heroin, morphine) tend to narrow the pupils. However, a permanent lack of oxygen due to opiate abuse (reduction in respiratory rate) can in turn lead to dilation of the pupils (mydriasis).

Large pupils can also result from poisoning. A list of possible poisons are: benzene, chloroform, datura, mushroom poisoning . Non-fatal causes of large pupils can also include: a disorder of the cranial nerve, a muscle that controls most eye movements; increased intraocular pressure.

Life-threatening causes of large pupils can include: brain aneurysm (weakening of an artery in the brain that can rupture and cause extreme damage); brain tumor; cerebral edema (swelling of the brain); head injury; increased pressure in the head; internal bleeding in the head; skull fracture; Stroke.

Diseases

Typical diseases with large pupils:

• cerebral edema

• stroke

• brain tumor

• head injuries

• skull fracture

When to the doctor?

Large pupils that appear in dim light sources or in the dark are normal. Even if the pupils dilate with great interest or positive and negative emotions, this is harmless and a doctor’s visit is not necessary. Pupils also dilate after drug use. You can wait until the substance has broken down in the body. However, if the drugs are strong and the person concerned is no longer responsive or can no longer act rationally, a doctor must be consulted.

If a patient notices enlarged pupils, this may be due to the use of medication. Then the dosage should be checked with the doctor treating you. Additional language problems could be signs of a stroke. It must also be clarified whether tumors, an aneurysm or edema are responsible for the large pupils.

Poisoning can be accompanied by large pupils. In these cases, a doctor must be consulted immediately. After accidents, enlarged pupils indicate serious injuries. A doctor must be consulted as soon as possible in order to initiate emergency medical measures in the event of cerebral hemorrhage , contusion of the brain and fractured skull.

diagnosis and course

Based on the large pupils and the additional symptoms, the doctor will try to make a diagnosis and learn the cause of the patient’s condition. Pupils that are different in size or wide and fixed should provide the greatest alert. After drug abuse or an eventual overdose, other symptoms may appear in addition to the large pupils.

These may include: confusion and fainting ; very dry mouth ; increased heartbeat; slurred speech ; vomiting . In some cases, large pupils are an indication of a life-threatening disorder or injury. In this case, the emergency service should be alerted immediately.

Other symptoms include: persistent and recurring fainting; violent mood swings; inability to speak ; hallucinations ; loss of perception; muscle weakness ; inability to move; convulsions ; severe headache ; visual disturbances or loss of vision; vomiting .

complications

Large pupils are caused, for example, by the influence of illegal drugs. Those affected usually also have slurred speech and suffer from dizziness and hallucinations. This is often accompanied by nausea and vomiting. Chronic drug abuse can also lead to mental illnesses such as anxiety and panic disorders or psychoses and personality changes. These can end in depression. Furthermore, poisoning by drugs can lead to a coma and even death.

In addition, diseases of the brain can also cause enlargement of the pupils, such as cerebral edema. This can also trigger a life-threatening condition. The edema can increase the intracranial pressure, and in addition to visual disturbances, there is also a clouding of consciousness. The brainstem, which contains important regulatory centers of the organism, can also be trapped. This can lead to respiratory arrest, coma and even death.

A stroke also dilates the pupils. Depending on the localization of the stroke, there are corresponding failure symptoms. For example, the person affected may have problems speaking and hearing, but may also be restricted in their movement. It is not uncommon for incontinence to occur , so that the person concerned needs care. The complications can be permanent if left untreated. Immediately after a stroke, the risk of suffering an epileptic seizure or getting a urinary tract infection is increased.

treatment and therapy

Treatment for large pupils depends on its cause. The presence of other symptoms, the age and medical history of the person affected are ways to determine the cause. Treatment involves addressing the causative disorder or poisoning and preventing aggravation.

If it is a neurological problem, inpatient treatment is necessary. These include head injuries, brain hematomas, brain aneurysms, strokes, increased intracranial pressure or a brain tumor. Rapid surgery may be needed if there is a hematoma and increasing pressure on the brain. For this purpose, the skull is opened and the escaping blood is pumped out to reduce the pressure.

There is also individual emergency treatment for severe poisoning or overdose, which usually requires hospitalization. If the dilated pupils are caused by abuse of an illegal drug, the patient will also remain under observation for a while.

It may be advisable in some cases to initiate rehabilitation and accompanied withdrawal. This treatment can consist of both inpatient and outpatient care, medical observation, psychological counseling and, if necessary, care work.

prevention

Preventing large pupils means preventing the causes. Since the causes can be very different, so are the preventive measures. The most serious cause of large pupils is brain damage. These are usually caused by head injuries or impacts to the head.The symptoms of a hematoma (such as large pupils) often appear very late, so the connection with the injury can often not be established. In order to prevent this cause, you should always buckle up when driving a car and wear a protective helmet when cycling, inline skating, skateboarding, etc. Tumors cannot be prevented; it is important to recognize it early and take medical measures.

Large pupils caused by poisoning can also only be prevented by caution. Mushrooms collected in the forest should only be eaten when there is no doubt about their edibility. Children should be well informed that they should not eat unfamiliar berries or plants.

outlook and prognosis

If the enlarged pupils occur due to a change in the incidence of light, the complaint usually disappears when the eye is exposed to normal lighting again. The complaint is not dangerous to health and does not lead to further complications or restrictions.

Even with drug use, the enlarged pupils usually disappear after a few hours or a few days and there are no further complications. However, long-term abuse of the drugs can have a very negative effect on the health of the body and also on the health of the eyes and in the worst case can lead to visual impairments or complete loss of vision.

Even with a tumor, the life expectancy of the patient is reduced in most cases and vision is impaired. The removal of the tumors can possibly limit and reduce the symptoms. However, a general course of the disease cannot be specified. In the case of injuries, no general prediction is possible, since the further course of this disease depends on the cause and severity of the injury.