How Drugs Affect the Eye: Dilation, Pinpoint Pupils, Redness & More

Your eyes are the window to the soul, and they can tell a lot about your health. These organs of vision can reveal things like infections, allergies, and other health conditions. 

Drugs can affect your eyes in a variety of ways, and these effects can be signs of greater damage.

Eye Changes That Drugs Can Cause 

Eye changes are a common side effect of many drugs. Some of these changes may be temporary, but others may be permanent.

If you notice any sudden or unusual changes in your vision after starting a new medication, you must talk to your doctor immediately.

Here are some of the most common eye changes that drugs can cause:

1. Dilated Pupils

Dilated pupils look larger than usual, usually two to three times their normal size. This change in proportions is attributed to the effects of certain drugs on the nervous system. In most cases, the dilation of pupils happens with drugs that increase dopamine in the brain.

The size of your pupils also changes depending on how much light there is around you. Your pupils will be dilated when you’re in a dimly lit room or in a dark area of a building.

2. Constricted (Pinpoint) Pupils

If your pupils look like two tiny dots even when they’re relaxed, it’s called miosis. The most common cause of miosis or pupil contraction is an issue with the iris sphincter muscles or nerves that control them.

3. Double Vision

Double vision, also known as diplopia, happens when you look at an object with both eyes, but the image on each retina is slightly different from the other, so your brain sees two images instead of one. This effect can be caused by drugs that influence the signals sent from one part of your brain to another, such as stimulants, sedatives, and tranquilizers.

4. Blurry Vision

Blurry vision is a common side effect of recreational drugs, and it can last for hours or even days after you use certain drugs. It’s caused by how your brain processes visual information in response to the drug, and it can make it hard for you to drive, work, or do other tasks that require good vision.

5. Cataracts

Cataracts are one of the most serious side effects of recreational drug use. For example, smoking can lead to cataracts over time. 

A cataract is an opacity or cloudiness of the eye’s lens that may make it harder to see clearly. Cataracts are not painful, but they make it hard to see well and can lead to blindness if they aren’t treated immediately. 

6. Nystagmus

Nystagmus is an involuntary eye movement that occurs when the eyes are at rest. This condition can affect one or both eyes, and it can be horizontal, vertical, rotatory, or a combination of these.

It can cause dizziness, nausea, and headaches, as well as blurred vision because your eyes aren’t able to focus properly on anything within their range of motion.

This condition happens when recreational drugs affect serotonin levels in the brain, which controls muscle contractions, including those that cause eye movements.

7. Drooping Eyelids

The effects of recreational drugs on the eyes are not always immediately noticeable. However, if you have been using opioid drugs for a long time or have overdosed on them, you may notice that your eyelids begin to droop. This condition is called ptosis, and it’s caused by muscle paralysis or damage to nerves that control the muscles in your eyelids.

This makes it difficult for you to see and can cause other problems with vision as well.

8. Watering Eyes

Like drooping eyelids, watering eyes are another common sign of drug use and addiction. This condition is caused by an overproduction of tears due to stress on the tear glands from long-term abuse of recreational drugs. 

The constant production of tears will cause them to overflow from your eyes, making them look red and irritated.

9. Red Eyes

Red eyes are a common side effect of recreational drugs like marijuana.

The condition is caused by vasodilation, which is a widening of the blood vessels in the eye. This can lead to increased pressure in the eye, causing it to appear red.

Vasodilation occurs when drugs like cocaine bind to receptors on nerve cells that normally regulate smooth muscle contraction and relaxation.

10. Yellowed Eyes

Yellowed eyes are a common sign of liver damage, and it’s one of the most common symptoms of drug abuse.

When you take certain drugs, like heroin or cocaine, your liver is forced to work overtime to metabolize the chemicals in those drugs. This can lead to liver damage and jaundice — a condition where your skin and eyes turn yellowish.

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Eye Changes Based on Specific Drugs 

Eye changes will vary according to the type of drugs used as well as the dosage level and other personal conditions. 

• Alcohol: Alcohol is the most common cause of blurry and double vision among chronic drinkers. 
• Amphetamines: Amphetamines (including prescription stimulants like Adderall) may cause the pupils to dilate and the iris to contract, making it difficult for light to pass through your eye. This can lead to severe light sensitivity and impaired vision in bright light.
  Other types of amphetamines include ecstasy, Molly, MDMA, and more.
• Benzodiazepines: Benzodiazepines are a class of drugs that includes Valium and Xanax, among others. These drugs can cause your pupils to dilate with an overdose. With smaller doses, they can cause altered, double, and cloudy vision. 
• Cigarettes: The smoke from a cigarette can cause the blood vessels in the eye to become inflamed, leading to macular degeneration. Cigarette smoke can also cause cataracts, glaucoma, and retinal detachment.
• Cocaine: Cocaine causes pupils to dilate, which makes them look bigger. Overdose leads to hallucinations and other visual disturbances, such as seeing trails behind moving objects.
• GHB: GHB is a depressant that acts on your central nervous system and slows down your breathing rate, heart rate, and blood pressure. When used for recreational purposes, through an eye dropper, it can cause hallucinations.
• Hallucinogens: Hallucinogens (also known as psychedelics) are a class of drugs that cause hallucinations. They can cause the pupils to dilate and the eyes to become sensitive to bright light. 
• Heroin: Heroin causes drooping eyelids and can lead to pinpoint pupils in some cases. This is one of the primary symptoms of heroin use.
• Inhalants: The eyes tend to water and become red when you inhale substances like paint thinner or glue, which are common inhalants.
• Ketamine: Ketamine is a dissociative sedative that causes hallucinations, loss of coordination, and feelings of detachment from the environment. This drug dilates your pupils and may sometimes lead to rapid eye movement.
• Marijuana: Marijuana is a psychoactive drug derived from the Cannabis sativa plant. The drug causes red eyes when used excessively. 
• Methamphetamine: This is a stimulant that increases energy levels and causes an increased sense of alertness. As such, this drug can cause rapid eye movement.
• Narcotics: Abusing narcotics like heroin, morphine, and fentanyl can constrict your pupils. An overdose of the same can also lead to pinpoint pupils.
• PCP (phencyclidine): A person high on PCP often exhibits rapid eye movements, blank stares, and confusion.
• Poppers: Brain damage and maculopathy are the two major causes of irreversible vision loss due to abusing poppers.

Attempts to Conceal Eye Changes 

There are different ways you can conceal eye changes caused by drug use. Here are four of the most common methods:

1. Eye Creams

Apply a highlighter under your eyebrows. This is one of the best ways to ensure that people don’t notice any discoloration in your skin tone caused by drug use around your eyes. Highlighter works well because it helps to brighten up areas where light naturally hits.

2. Colored Contacts

Contact lenses are a good way for those who don’t want their own eyes changed but still want them hidden from others’ views. They come in many different colors and styles, so you can still have some individuality while concealing your eyes somewhat.

3. Tinted Concealer

Makeup has been used for centuries to conceal eye changes, which is still one of the best ways to do so today. You can use makeup to cover any discoloration with concealer or foundation and then add color back in with eyeshadow or eyeliner.

4. Wear Sunglasses

When you’re wearing sunglasses, it’s harder for people to see your eyes. This is especially helpful if you have dark circles under your eyes or redness around them. 

Long-Term Damage & Eye Issues From Substance Abuse

Substance abuse is a growing problem in the United States. It can lead to long-term damage and eye issues, including blindness. 

According to the National Institute on Drug Abuse (NIDA), drug abuse affects your body with direct and long-term damage. Direct damage is immediate and can happen within minutes. Long-term damage is caused by repeated use of a substance over time.

Here are some of the most common types of long-term damage and eye issues from substance abuse:

• Glaucoma: Glaucoma is a disease that damages your optic nerve and can lead to blindness if left untreated. It is triggered by increased pressure in your eye, which can be caused by many things, including drug use, infection, or high blood pressure.
  
  If you suspect you have glaucoma, see an eye doctor immediately for treatment options before it’s too late.
• Retinopathy: This condition affects blood vessels in the retina of your eye, causing them to become damaged or leaky over time. This can lead to vision loss or even total blindness if left untreated.
  If you think you have retinopathy, seek medical attention immediately, so treatment can begin as soon as possible.
• Corneal ulcers: Corneal ulcers are a serious condition that can lead to blindness if not treated properly. The most common cause of these ulcers is drug use, which damages the corneal tissue and makes it more susceptible to infection.
  These infections can cause scarring on your cornea, which leads to an increase in pain and sensitivity to light. If left untreated, corneal ulcers will lead to blindness.
• Dry eye syndrome: Dry eye syndrome is another common condition resulting from drug or alcohol abuse. Dry eye syndrome causes symptoms like burning, itching, tearing, and blurred vision — all of which can be very painful. If left untreated, dry-eye syndrome can lead to permanent damage, such as loss of vision or blindness.
• Macular degeneration: This condition affects the macula (which is responsible for central vision). It causes blurry vision and difficulty recognizing faces. If left untreated, macular degeneration can lead to complete blindness.

Can Eye Damage From Substance Abuse Be Corrected?

Yes, in most cases. The good news is that many eye problems associated with substance abuse can be effectively treated.

The first step to recovery is identifying what kind of substance abuse you’re dealing with and then seeking help. 

There are many different types of substance abuse, and each one will require a different treatment plan to address the specific issues your eyes face due to these substances. See a doctor to have all existing eye issues appropriately diagnosed.

Treatment for Drug-Related Eye Issues

Drug-related eye issues can range from mild to severe, and they often require different treatments depending on the severity of the condition.

For mild cases of dry eye, over-the-counter artificial tears can be used to relieve symptoms. If you experience more severe symptoms, you may need prescription eye drops or ointments. Some people also find relief from over-the-counter lubricating eye products.

If your drug use has caused you to develop glaucoma or cataracts, you will likely need surgery to remove or repair the damage. 

If you’re experiencing any changes in your vision, it’s important to see an optometrist right away for an accurate diagnosis and treatment plan.

Resources for Those Struggling With Substance Abuse

Substance abuse is a serious issue that affects millions of Americans. It’s important to remember that recovery isn’t easy and takes time, but it’s possible. While there is no cure for addiction, it can be effectively managed for the long term.

Here are some resources to get started:

• Substance Abuse Treatment Facility Locator: The Substance Abuse and Mental Health Services Administration (SAMHSA) provides this searchable database of treatment programs across the country. You can search by location, type of treatment program, or other criteria. They also have a hotline you can call 24 hours a day at 1-800-662-HELP (4357).
• National Institute on Drug Abuse: NIDA provides information on drug addiction and its causes, treatment options, and more. It also offers tips for parents of children with drug addictions.

National Council on Alcoholism and Drug Dependence: NCADD is one of the best resources for those who need help getting sober. The organization provides information about treatment options and recovery programs, as well as resources for those who have lost a loved one to addiction.

References

1. 20 Surprising Health Problems an Eye Exam Can Catch. (April 2022). American Academy of Ophthalmology.

2. Illicit drugs: Effects on the eye. (September 2019). The Indian Journal of Medical Research.

3. Pharmacologic Dilation of Pupil. (September 2022). American Academy of Ophthalmology.

4. Diplopia. (February 2022). StatPearls.

5. Pupillometry: Psychology, Physiology, and Function. (February 2021). The Journal of Cognition.

6. What Are Cataracts? (September 2022). American Academy of Ophthalmology.

7. Nystagmus. National Library of Medicine.

8. What Is Ptosis? (September 2022). American Academy of Ophthalmology.

9. Benzodiazepines and Opioids. (April 2022). National Institute of Drug Abuse.

10. GHB – Gamma-Hydroxybutyric Acid. U.S. Drug Enforcement Administration.

11. SAMHSA releases 2020 National Survey on Drug Use and Health. (October 2021). Substance Abuse and Mental Health Services Administration.

12. Find Treatment. Substance Abuse and Mental Health Services Administration.

13. NCADD Can Help. National Council on Alcoholism and Drug Dependence.

14. Ocular Manifestations of Drug and Alcohol Abuse. (August 2015). Current Opinion in Ophthalmology.