Large pupils can occur due to a wide variety of injuries, disorders or diseases. These include tumors, head injuries, or drug abuse, for example.
What are large pupils?
Because large pupils have a wide variety of causes, the measures for prevention also vary widely. The most serious cause is brain damage. A pupil is an opening in the iris of the human eye through which light can enter. This is how vision is made possible. In high brightness, the pupil is usually narrow; large pupils are a response to insufficient light in the environment. In a dark room, the pupils dilate to allow more light to enter. The iris also responds to emotional arousal by dilating or contracting the pupils. Medicinal eye drops, called mydriatics, can also cause large pupils. These are mainly administered when the doctor wants to artificially dilate the pupils to study their reaction to light incidence. However, they also occur as a symptom of a wide variety of diseases, including neurological problems, tumors, head injuries, poisoning, or drug ingestion. If large pupils no longer respond to light and remain completely fixed, this is an indication that death has already occurred.
Causes
A common cause of large pupils is the use of illicit drugs or medications such as antihistamines (Allermax, Allergia-C, Benadryl, Aller-Chlor, Chlor-Trimeton, Allerlief), cocaine, marijuana, amphetamines, atropines, decongestants such as pseudoephedrine, cannabis, LSD, heroin, or methamphetamines. Large pupils also occur due to poisoning by chloroform, benzene, datura or mushrooms. Another possible cause is a disorder of the so-called cranial nerve, which is responsible for controlling eye movements. In addition, a brain aneurysm, brain tumor, head injury or cerebral edema can also be behind dilated pupils. If a dilated pupil only occurs on one side, this may indicate a cerebral contusion or cerebral hemorrhage due to a craniocerebral injury. Furthermore, large pupils also occur with a skull fracture, internal bleeding in the head, or stroke.
Diseases with this symptom
- Drug addiction
- Skull fracture
- Aneurysm
- Cerebral edema
- Brain tumor
- Brain hemorrhage
Diagnosis and course
During a medical examination, the physician will try to find the cause of large pupils based on additional symptoms. In the first place of the diagnostics is the anamnesis. If it is not possible for the patient to take the history himself, the patient’s relatives will take the history. The physician asks questions about any previous illnesses, traumas or infections. Depending on the cause, a clinical examination may include a neurological examination, an electroencephalography (EEG), a cranial computed tomography (CCT) or a reflection of the back of the eye. There is a great danger if the pupils are rigid and wide or different in size. Other symptoms may also occur after drug ingestion. These include fainting, increased heart rate, confusion, vomiting, or a very dry mouth. Since large pupils can often also be a warning sign of a life-threatening disorder, an emergency physician should be alerted in these cases. Other symptoms that occur in addition to large pupils include: Hallucinations, inability to move, headaches, loss of vision or visual disturbances, mood swings or convulsions. Based on these symptoms, the doctor is able to make a more accurate diagnosis.
Complications
Large pupils can be caused by a variety of conditions, diseases, or injuries, and the possible complications are just as varied. Dilated pupils after drug abuse can be signs of an overdose and are usually accompanied by confusion or fainting, an increased pulse rate, and slurred speech. Wide complications can include: Hallucinations, headaches, visual disturbances, and in extreme cases, complete loss of vision due to what is called vascularization in the area of the pupils.Large pupils as a result of a head injury often cause nausea and vomiting, as well as blurred vision and other symptoms. If the symptom is due to a brain injury, the patient’s life may be in danger in extreme cases. The same applies to poisoning, head trauma or a stroke. Depending on the cause, emergency surgery must be performed, which carries the risk of permanent damage. If the patient is treated with medication, there is a risk that the complaints will increase and that further symptoms will occur. Finally, certain underlying diseases such as acanthamoebic keratitis may lead to vascularization, i.e. growth of blood vessels in the cornea, often accompanied by secondary bacterial infections in the pupil area. Because of the variety of possible complications, large pupils should be evaluated by a physician, especially if chronic.
When should you see a doctor?
Pupils usually appear only in low light or darkness. It also happens that pupils temporarily dilate when someone is looking at something with great interest or is generally emotionally aroused. Some medications can also cause dilated pupils as a side effect. Otherwise, large pupils occur from less innocuous causes and should be examined by a doctor. Numerous causes are possible for large pupils. Brain diseases such as a tumor, edema or aneurysm are among them, as well as a disturbed cranial nerve that controls eye movements. Large pupils can also indicate a skull fracture, cerebral hemorrhage or cerebral contusion and thus provide important medical information in accidents, among other things. Likewise, various poisonings trigger pupil dilation. It is also known that large pupils occur in the case of illegal drug use. Although drug users themselves are unlikely to seek medical attention voluntarily for this reason, when a helpless person is found, large pupils provide indications of possible drug abuse. A dilated pupil can also be unilateral, affecting only one eye. A visit to the doctor is therefore always indicated in the case of large pupils if none of the harmless causes mentioned at the beginning apply to this. It may even be advisable to call the emergency doctor right away.
Treatment and therapy
Depending on the cause, the treatment of large pupils is carried out. In this case, the doctor will act against the triggering disorder and prevent it from worsening. If the cause is a neurologic problem, the patient will require inpatient treatment. These include strokes, brain aneurysms, head injuries, brain tumors, brain hematomas or increased internal pressure in the skull. In the case of the latter, rapid surgery may also be necessary. This involves opening the skull to pump out blood, which can reduce the pressure. A stay in hospital is also usually necessary after taking drugs or in cases of severe poisoning. In addition, rehabilitation or withdrawal may also be advisable. This type of treatment can be done on an outpatient or inpatient basis.
Outlook and prognosis
In many cases, the enlarged pupils occur when the patient has abused alcohol or other drugs. The symptom decreases after a short period of time and disappears completely when the particular drug has been eliminated from the body. In addition to large pupils, headaches, hallucinations, and nausea usually occur. Large pupils can also occur after an accident. Here, vomiting, dizziness and nausea usually also occur due to the shock. If the injury occurred to the head, it may be a concussion or head trauma. In these cases, a doctor must be seen urgently to treat the symptom. The large pupils also occur during snake attacks. In most cases, the symptom disappears on its own if it is not a serious cause. They occur mainly after the consumption of alcohol and do not pose a danger in ordinary quantities.
Prevention
Since large pupils have a wide variety of causes, the measures for prevention are also very different. The most serious cause is brain damage, which is very often triggered by head injuries. However, because the onset of symptoms is often delayed, it is difficult to make the correct connection.It is therefore advisable to always fasten your seat belt when driving and to wear a helmet when doing sports such as skateboarding, inline skating or cycling. A tumor can basically not be prevented, here it is important to detect and treat it early. Large pupils, which occur due to poisoning, can also only be prevented by caution. That is, mushrooms, berries or plants should be eaten only when there is no doubt that they are edible.
This is what you can do yourself
Large pupils can be caused by many conditions, diseases or injuries. Depending on the cause, various measures and home remedies help against enlarged pupils. Often, even a walk in the sun or contact with a light source will help reduce the size of the pupils. Quiet music and tea also have a relaxing effect and prevent enlarged pupils. So do various foods and drinks, as well as sports activity. Emotions and various other factors also influence the size and appearance of pupils. It is therefore advisable to first determine the cause of the changes. Altered pupils as a result of drug use can be cured by sleep and relaxation, while large pupils as a result of poisoning can be reduced again by various home remedies. In the case of other causes (head injuries, stroke, brain tumor, etc.), any measures should first be discussed with the attending physician. Accompanying steps can then be taken to correct the cause and thus also reduce the pupil size back to normal. The most effective home remedy for large pupils is always treatment of the trigger, accompanied by rest and bed rest.
