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Dilated pupils are the way the human body responds to many stimuli, including stress, excitement and light, or rather the lack of it. Pupils narrow in harsh light and widen in twilight. Dilated pupils are sometimes also a sign that the person we are dealing with is under the influence of intoxicants, including drugs. An eye disease or a neurological condition can also cause dilated pupils.
What is the pupil and why does it sometimes dilate?
The pupil is the opening in the iris of the eye. It regulates the amount of light that falls on the retina with the help of two muscles – the pupil sphincter and the pupil dilator muscle. The muscles of the pupil are innervated by the autonomic nervous system, which means that their movements are independent of the will.
In healthy people, the pupils react by narrowing when a light source is directed at them. If the light is directed at one of the pupils, it should narrow (direct reaction), while the pupil of the other eye should also react (consensual reaction).
In twilight or in a poorly lit room, the pupils are dilated because their task is to let the right amount of light into the retina of the eye.
In well-lit rooms and, for example, in bright light, the pupils naturally narrow.
Pupils can also dilate under the influence of an emotional stimulus (excitement, emotion, love) and stress. The sympathetic system, responsible for involuntary movements of the pupil muscles, is then stimulated, hence this reaction. It is a natural reaction of the human body – perhaps the lack of it under favorable conditions may be disturbing.
Causes of pupil dilation
The dilated pupils are sometimes caused by the application of eye drops or medications that block the parasympathetic system. Eye drops with atropine having such an effect are used in ophthalmological diagnostics. They cause pupil dilation and temporary paralysis of accommodation.
However, dilated pupils may also indicate a state of intoxication or the ingestion of psychoactive substances. Especially in adolescents, dilated pupils should arouse caregivers’ alertness.
The dilated pupils are caused by drugs such as amphetamines, cocaine, LSD, marijuana or legal highs.
Wide pupils may also indicate intake of tropane alkaloids, antihistamines, drugs for Parkinson’s disease, tricyclic antidepressants, drugs that suppress accommodation, and phenothiazines.
Dilated pupils are also the result of accidental or deliberate ingestion of plants such as henbane, nightshade, nightshade or Datura.
In some cases, the causes of dilated pupils are diseases of the nervous system or head trauma. In the event of any head injury, the first thing to do is to investigate the patient’s pupil response to light. Dilated pupils may indicate, among other things, a concussion. The neurological conditions causing mydriasis include: ischemic stroke, hemorrhage in the brainstem, aneurysm around the brainstem, viral or bacterial neuroinfection, tumor of the brainstem and base of the brain, or foci of softening in the midbrain.
Dilated pupils are also a symptom of syphilis, botulism and diphtheria polyneuropathy. This symptom usually indicates a poor prognosis for the patient.
Other causes of pupil dilation include, for example, eyeball infections and eye inflammation. This symptom is then usually accompanied by pain, photophobia and lacrimation.
If the pupil of only one eye is enlarged, this may indicate the presence of physiological anisocoria. This is not a cause for concern, but rather a beauty defect.
However, a strongly dilated pupil of one eye may indicate an acute attack of glaucoma, an aneurysm or tumor, and cerebral ischemia. It can also be the result of a craniocerebral trauma.
Strong pupil dilation occurs when the paraguchal nerve is damaged.
Management of dilated pupils
The management of mydriasis depends on the cause of the symptom. If pupil dilation is a natural response to light or emotion, don’t be alarmed. In other cases, this condition should be consulted with a doctor who will take appropriate steps towards diagnosis and treatment.
Oval-shaped dilated pupils, which do not react to light, should be of particular concern. This symptom usually indicates serious neurological disease.
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