Large pupils

Large pupils can occur due to a wide variety of injuries, disorders or illnesses. These include, for example, tumors, head injuries or the abuse of drugs.

What are large pupils?

Since large pupils have various causes, the measures for prevention are also very different. The most serious cause is brain damage.

The pupil is an opening in the iris of the human eye through which light can enter. In this way seeing is made possible. When the brightness is high, the pupil is usually narrow; large pupils are a reaction to insufficient light in the environment.

In a dark room, the pupils are dilated so that more light can enter. The iris also reacts to emotional excitement by expanding or contracting the pupils. Medical eye drops called mydriatics can also cause large pupils. These are mainly given when the doctor wants to artificially dilate the pupils in order to study their reaction to the light.

However, they also appear as symptoms of a wide variety of diseases, including neurological problems, tumors, head injuries, poisoning or the use of drugs. If large pupils no longer react to light and remain completely rigid, this is an indication that death has already occurred.

causes

A common cause of large pupils is the use of illegal 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 and methamphetamines.

However, large pupils also occur due to poisoning by chloroform, benzene, thorn apple 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, a brain tumor, a head injury or a brain edema can also be behind dilated pupils.

If a dilation of the pupil occurs on only one side, this can indicate a crushing or hemorrhage of the brain due to a traumatic brain injury. In addition, large pupils can also occur in the event of a skull fracture, internal bleeding in the head or a stroke.

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Diseases with this symptom

• Drug addiction
• Skull fracture

• Aneurysm
• Brain edema

• Brain tumor
• Cerebral hemorrhage

Diagnosis & course

As part of a medical examination, the doctor will try to find the cause of the large pupils based on additional symptoms. The anamnesis comes first in the diagnosis.

If this is not possible for the patient himself, a third-party anamnesis is made by relatives. The doctor asks questions about any previous illnesses, trauma or infections. As part of a clinical examination, depending on the cause, a neurological examination, electroencephalography (EEG), cranial computed tomography (CCT) or a reflection of the fundus can be carried out.

There is a great danger when the pupils are rigid and wide or different in size. Other symptoms may also occur after taking drugs. These include fainting, increased heartbeat, confusion, vomiting or a very dry mouth.

Since large pupils can often be a warning signal for a life-threatening disorder, an emergency doctor should be alerted in these cases. Other symptoms that appear in addition to large pupils are: hallucinations, inability to move, headache, loss of vision or visual disturbances, mood swings or convulsions. Based on these symptoms, the doctor is able to make a more precise diagnosis.

Complications

Large pupils can be caused by a variety of conditions, diseases, or injuries, and the potential complications are just as varied. Dilated pupils after drug abuse can indicate an overdose and are usually associated with confusion or fainting, increased heart rate, and slurred speech. Other complications can include hallucinations, headaches, visual disturbances and, in extreme cases, complete loss of vision caused by so-called vascularization in the pupil area.

Large pupils as a result of a head injury often cause nausea and vomiting, as well as blurred vision and other complaints. If the symptom is based on a brain injury, there is an extreme risk to the patient's life. The same applies to poisoning, head trauma or a stroke. Depending on the cause, an emergency operation has to be carried out, which carries the risk of permanent damage. When treating with medication, there is a risk that the symptoms will worsen and further symptoms will develop.

Finally, certain underlying diseases such as acanthamoeba keratitis can lead to vascularization, i.e. growth of the blood vessels in the cornea, often accompanied by secondary bacterial infections in the pupil area. Due to the large number of possible complications, large pupils should be examined by a doctor, especially if they are chronic.

When should you go to the doctor?

Pupils usually only appear in low light or dark. It also happens that pupils dilate temporarily when someone is viewing something with great interest or is generally emotionally aroused. Some medications can also cause dilated pupils as a side effect. Otherwise, large pupils appear from less harmless causes and should be examined by a doctor.

There are many possible causes of large pupils. Brain diseases such as a tumor, edema or aneurysm are part of it, as well as a disturbed cranial nerve that controls eye movements. Large pupils can also indicate a skull fracture, cerebral haemorrhage or brain contusion and thus provide important medical information in the event of an accident. Various types of poisoning also trigger a dilation of the pupil.

It is also known that large pupils occur during illegal drug use. Even if the drug users themselves are unlikely to voluntarily consult a doctor because of this, when they find a helpless person, large pupils provide clues to possible drug abuse. An enlarged pupil can also appear unilaterally, i.e. affect only one eye.

A visit to the doctor is therefore always indicated for large pupils if none of the harmless causes mentioned at the beginning apply. It may even be advisable to call the emergency doctor straight away.

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Treatment & Therapy

Treatment of large pupils is done depending on the cause. The doctor will take action against the triggering disorder and prevent it from getting worse.

If the cause is a neurological problem, the patient must be treated as an inpatient. These include strokes, brain aneurysms, head injuries, brain tumors, brain hematomas or increased internal pressure in the skull. The latter may also require rapid surgery.

This involves opening the skull to pump out blood, which can reduce pressure. A stay in hospital is usually necessary even after taking drugs or in the event of severe poisoning. Rehabilitation or withdrawal may also be advisable. This type of treatment can be carried out on an outpatient or inpatient basis.

Outlook & forecast

In many cases, the enlarged pupils occur when the patient has abused alcohol or other drugs. The symptom disappears after a short time and disappears completely when the drug in question has been broken down from the body. In addition to the large pupils, headaches, hallucinations and nausea also usually occur.

Large pupils can also appear after an accident. The shock usually also leads to vomiting, dizziness and nausea. If the injury occurred to the head, it could be a concussion or head trauma. In these cases, urgent need to see a doctor to treat the symptom. The large pupils also appear during snake fits.

In most cases, unless the cause is serious, the symptom will go away on its own. They mainly occur after consuming alcohol and are not dangerous in normal amounts.

You can find your medication here

➔ Medicines for eye infections

prevention

Since large pupils have various causes, the measures for prevention are also very different. The most serious cause is brain damage, which is very often caused by head injuries.

However, since the symptoms are often delayed, it is difficult to establish the correct connection. It is therefore advisable to always buckle up while driving and to wear a helmet for sports such as skateboarding, inline skating or cycling. In principle, a tumor cannot be prevented; it is important to recognize and treat it at an early stage.

Large pupils, which occur as a result of poisoning, can also only be prevented with caution. This means that mushrooms, berries or plants should only be eaten when there is no doubt that they are also edible.

You can do that yourself

Large pupils can be caused by many conditions, diseases, or injuries. Depending on the cause, various measures and home remedies can help against enlarged pupils. A walk in the sun or contact with a light source often helps to reduce the size of the pupils.

Quiet music and tea also have a relaxing effect and prevent enlarged pupils. Likewise, various food and drinks as well as sports activities. Emotions and various other factors also influence the size and appearance of the pupils. It is therefore advisable to first determine the cause of the changes. Changes in pupils as a result of drug use can be cured through sleep and relaxation, while large pupils as a result of poisoning can be made smaller 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 treating doctor. At the same time, steps can then be taken to eliminate the cause and thus also reduce the pupil size to normal again. The most effective home remedy for large pupils is always treatment of the trigger, along with rest and bed rest.