Ocular Changes in Drug Misuse

Features to look for:

(1) diameter of the left pupil

(2) diameter of the right pupil

(3) nystagmus

(4) light reflex

(5) ability to track visually

(6) photophobia

(7) tearing

Both pupils small (miosis; "pinpoint")

(1) ethanol (with nystagmus and eyelid droop)

(2) barbiturates (with nystagmus and eyelid droop)

(3) benzodiazepines (with nystagmus and eyelid droop)

(4) marijuana

(5) clonidine

(6) chloral hydrate

(7) phenothiazines

(8) nicotine

Both pupils large (mydriasis):

(1) cocaine

(2) amphetamines

(3) MDMA

(4) ketamine

(5) flunitrazepam

(6) LSD or other hallucinogens

(7) jimson weed or other drugs with anticholinergic activity (atropine-like)

No change in diameter:

(1) phencyclidine (PCP, shows nystagmus)

(2) polypharmacy

Head or neck trauma secondary to the intoxication can result in:

(1) pupils unequal (anisocoria, discussed in  Chapter 19)

(2) midrange and fixed

Problem areas:

(1) a person with only 1 eye

(2) a person in coma