Help! My pupil suddenly turned into a triangle. Is it a sequelae of COVID-19? The truth is...

A few days ago, someone posted online: "The day before yesterday, my right eye was a little itchy and red. I thought it was conjunctivitis or a stye. Yesterday morning I bought some levofloxacin hydrochloride and took some drops. It's a little better now. This morning I went to the ophthalmology department for an appointment. The doctor said your pupil is triangular. I was shocked..."

The netizen attached a photo of his eyes and said: "My pupils became triangular overnight. I'm so scared. What's the problem? My eye pressure, vision, and light sensitivity are all normal. I can't see blurry. I haven't had any surgery, and my eyes haven't been injured."

From the photo, there is a dark triangle area in the center of the netizen's right eye, which is the pupil. The pupil of an average adult is a perfect circular hole with a diameter of about 2-4 mm. The triangular pupil of this netizen is a deformed pupil, which is an abnormal condition. Generally speaking, it means that the eye has a disease.

01

Is pupil turning into a triangle a sequelae of COVID-19?

Let me first state the conclusion: It isn’t.

After the post was published, some netizens asked if this was a sequelae of the COVID-19. In fact, this is not a sequelae of the COVID-19. There were many cases of sudden pupil deformation long before the emergence of the COVID-19. In 2016, it was reported that someone found that his eyes were very red after working overtime for a week, and it did not get better after using eye drops for several days. One day, after waking up, he found that his pupils had turned into a heart shape.

Some people's pupils turned into the shape of mangosteen pedicles:

Some people's pupils have become olive-shaped:

In addition to the above types, there are many other strange deformations of pupil abnormality. But no matter what shape it is, if the pupil suddenly changes to this shape, it means that the eye is likely to have a disease, so be careful. For example, the netizen whose pupil suddenly changed to a heart shape was diagnosed with uveitis. Recently, the netizen whose pupil changed to a triangle also went to the hospital for treatment and was diagnosed with iridocorneal endothelial syndrome .

02

What is iridocorneal endothelial syndrome?

Iridocorneal endothelial syndrome is a general term for three different eye diseases, including Chandler syndrome, primary or progressive iris atrophy and Cogan-Reese iris nevus syndrome, all of which are different variants of abnormalities in the corneal endothelial cells .
Symptoms include corneal edema, progressive closure of the anterior chamber angle, often accompanied by glaucoma, and a range of iris changes.

It is not clear what causes it . Although many scholars believe that it may be caused by inflammation or viral infection, it has not been possible to replicate the disease by infecting animals with viruses. Among various traditional virological detection methods, only PCR tests of some patients can obtain positive results. Therefore, the cause of this eye disease is still unclear.

Patients with iridocorneal endothelial syndrome are mainly middle-aged and young women. Symptoms usually occur after waking up in the morning, and the symptoms will be alleviated or disappear in the afternoon . Most patients have unilateral disease.

The initial symptoms are usually the discovery of abnormal iris, abnormal pupil shape and position, decreased vision and eye pain. In the early stage of the disease, there will be complications of corneal edema and blurred vision, and about half of the patients will develop glaucoma in the later stage . Because the cause is not yet clear, doctors do not have an ideal treatment for it. Generally, some relief is done for its complications . For example, for corneal edema, hypertonic saline eye drops or soft corneal contact lenses can be used; for early glaucoma, drugs that inhibit the production of aqueous humor can be used. When intraocular pressure cannot be controlled by drugs, glaucoma filtration surgery is required to control intraocular pressure. For patients with corneal endothelial decompensation, penetrating keratoplasty may be required.

03

If you experience these eye symptoms, seek medical attention immediately

The netizen mentioned above had an abnormal pupil shape, which was discovered by a doctor in the hospital. So in life, when we find that our eyes have certain symptoms, we need to seek medical attention in a timely manner?

1. Abnormal vision and decreased vision

If your eyes were fine the day before, but suddenly you feel things are distorted the next day, such as the edge of the table is not straight, or the wall clock is not round. Or if you feel your vision is a little blurry, and there is a dark shadow blocking your vision, your vision is impaired, and your vision suddenly decreases.

Copyright images in the gallery. Reprinting and using them may lead to copyright disputes.

These symptoms are often signals of retinal or intracranial lesions , and you need to see an ophthalmologist immediately.

The treatment time window for some diseases is very narrow. For example, for eye stroke and cerebral stroke, if the best treatment time is missed, it will cause permanent vision damage or even irreversible blindness.

2. Sudden eye pain or headache

If you experience eye pain, redness, congestion, photophobia, and tearing, accompanied by headaches, nausea, vomiting, and other symptoms, and your vision becomes blurred, as if through a layer of fog, and rainbow circles appear around the lights, this may be an acute glaucoma attack .

Once acute glaucoma occurs, it progresses very quickly and can cause complete blindness in as little as 24 to 48 hours, so be sure to see an ophthalmologist as soon as possible.

3. Red, swollen and painful eyes with increased discharge

If your eyes are red, swollen, painful, or have increased secretions, there are many reasons for this, but a common reason may be inflammation of the eye . Eye inflammation is most likely inflammation of the ocular surface, such as keratitis, conjunctivitis, etc. These eye diseases generally do not cause obvious changes in vision. Intraocular inflammation is relatively rare. If it occurs, it may be caused by bacteria, fungi, or parasites inside the eyeball, such as uveitis; or microorganisms from other parts of the body have invaded the inside of the eye, such as bacterial endocarditis, purulent meningitis, and sepsis. Intraocular inflammation is generally accompanied by decreased vision and blurred vision. In either case, it is recommended to seek medical attention in a timely manner to find the cause of the inflammation.

4. Swelling of the eyelids, accompanied by redness, heat and pain

If your eyelids are red, swollen, hot, painful, or itchy, it could be a stye . When a stye first appears, applying a warm compress to the affected area will usually help it go away. But if it's severe enough to form yellow pustules, you need to go to the hospital and have the doctor remove the abscess surgically.

Copyright images in the gallery. Reprinting and using them may lead to copyright disputes.

If you find a lump inside your eyelid, but it is not accompanied by redness, swelling, heat, or pain, it may be a chalazion. Chalazions generally have no obvious symptoms in the early stages, which means the lump will grow larger and larger. However, if the eyelid shows symptoms of redness, swelling, heat, and pain, it may be that the chalazion combined with the stye is infected, and its symptoms are very similar to those of a stye. In this case, it is also recommended to seek medical treatment in a timely manner.

5. One pupil is larger than the other

Normally, the left and right pupils of a person should be symmetrical. If one pupil is larger than the other, or one pupil contracts more slowly or to a lesser extent, this may be an early sign of a disease such as a stroke, a brain tumor, or an optic nerve tumor .

6. Seeing things in pairs

If you do not have severe astigmatism but suddenly experience double vision (seeing one object as two), this may be caused by paralysis of the muscles around the eyes or by intracranial lesions, such as cerebral stroke or intracranial tumor. In this case, it is recommended to see an ophthalmologist or neurologist immediately.

7. Protruding eyes

Don't think that only people with high myopia will have protruding eyes. Another common cause of protruding eyes is thyroid disease . Other symptoms include eyelid edema, increased tears, limited eye movement, double vision, blurred vision, etc., which may lead to blindness. It is also recommended to seek medical attention in time if this happens.

Other diseases such as thyroid problems can also cause protruding eyes.

There are also some diseases that can cause proptosis, such as orbital tumors, orbital inflammation, intraocular tumors, pseudotumors, and ocular metastasis in the late stage of leukemia. Therefore, it is recommended that people with symptoms of proptosis go to the hospital immediately for treatment.

8. Drooping eyelids

Drooping eyelids do not necessarily mean lack of energy or loose skin around the eyes due to aging. It may mean myasthenia gravis.

If ptosis is accompanied by symptoms such as headache, eye pain, difficulty in eye movement, double vision, etc., it may be the acute onset of diabetes, intracranial aneurysm, cerebral stroke, or brainstem disease. It is recommended to go to the hospital immediately for treatment.

9. Foreign objects in the eye

If a foreign object gets into your eye, do not rub it hard. Blink your eyes more often to let the foreign object flow out with tears. Or tilt your head and rinse your eyes with clean running water to wash away the foreign object. If the foreign object is deep and cannot be flushed out successfully, please go to an ophthalmologist immediately .

10. Eye injury

If your eyes are scratched or bruised by a sharp or blunt object, do not remove the foreign body by yourself. If the contents of the eye come out, do not push them back into the eye to avoid infection. Do not rinse with water or apply medicine.

You should lie down immediately and gently cover the injured eye with a clean dressing (but not too tight) to reduce the exposure of the wound. Be careful to cover the uninjured eye as well, to prevent the injured eye from moving when the healthy eye moves, which would aggravate the injury.

Then go to the hospital immediately , and be careful not to bump on the road. If it is not treated in time or treated improperly, it is easy to aggravate the infection and even cause blindness.

11. Chemical burns to the eyes

If an unknown chemical substance enters your eyes, you must immediately turn your head and rinse your eyes with plenty of running water for 15 to 30 minutes (sterile saline is best). If an alkaline chemical substance enters your eyes, the harm is greater and you will need to rinse longer.
During the flushing process, you should keep moving your eyeballs and blinking to allow the chemicals in the eye to be fully flushed out. Go to the hospital for treatment in time after the flushing is completed.

12. Eye burns from ultraviolet rays

If you do not protect your eyes properly when engaging in outdoor activities with strong ultraviolet rays, such as in the mountains, at the seaside, on the snow, on the ice, in the desert, or when using ultraviolet lamps or electric welding, your eyes are likely to be burned by the ultraviolet rays and suffer from photoelectric conjunctivitis .

When doing outdoor sports or working, be sure to wear sunglasses or goggles. Copyright images in the gallery, reprinting and using may cause copyright disputes

The symptoms may occur after half an hour at the fastest and after 6 to 8 hours at the slowest. The initial symptoms include foreign body sensation and stinging in the eye. When the symptoms worsen, photophobia, tearing, eyelid closure, spasm, conjunctival congestion and edema may occur. See a doctor immediately if any of these symptoms occur. If you endure the discomfort and delay seeing a doctor, it may lead to further corneal infection or even keratitis.

04

Conclusion

In fact, there are more situations that require going to the hospital than the ones mentioned above. If you feel discomfort in your eyes or have symptoms, it is recommended to see an ophthalmologist and get an examination. More importantly, in daily life, we must take good care of our eyes, look far away more, rest more, do not stay up late, eat more eye-protecting foods, and ensure adequate sleep to keep our eyes bright forever.

Author: Xiaofang Cui Haoran (Doctor Tao Yong's Science Studio)

Reviewer: Tao Yong, Director, Professor, Doctoral Supervisor, Department of Ophthalmology, Beijing Chaoyang Hospital