A 28-year-old female asked:
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i had a bad case of optic neuritis in my eye a year ago w/ ms. i notice that pupil is almost always dilated larger still. normal? or cause for concern

3 doctor answers
Dr. Mark Fisher
33 years experience Neurology
Dilated pupil: Presumably what happened is that you sustained optic nerve damage & the nerve is not transmitting enough light data to tell the pupil to contract more. The "afferent limb" of the "direct" light reflex is damaged. If a light shined in your other eye causes the dilated pupil to contract, then the "consensual" light reflex is intact. That's called a Marcus-Gunn pupil.
Answered on Dec 28, 2016
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Dr. Eric Kelts
24 years experience Neurology
Yes: It is not that unusual to have a persistent pupillary abnormality following optic neuritis. Usually it is only detectable by someone performing a "swinging flashlight test" (usually an eye doctor) but sometimes can be seen by the patient or family member in normal light.
Answered on May 21, 2016
Dr. Bennett Machanic
51 years experience Neurology
Not surprising: Your eye likely still displays what is called an afferent pupillary defect, and dilates with light exposure. Do not be alarmed. But, if you have a diagnosis of MS, why do you not list an MS disease modifying agent, which would be critical in controlling future issues? Do you not have a neurologist who focuses in MS??
Answered on Nov 22, 2014

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Dr. Jeffrey Whitman
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Unknown: Most with optic neuritis never develop ms. I would see a neurologist for a complete evaluation if you are concerned.
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Dr. Daniel Gradin
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Ask for a referral: Ask your eye doctor if it is possible to have a referral to a neuro-ophthalmologist, or to a university eye clinic.
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