Which Drugs Cause Pinpoint Pupils?

Drug use can cause many physical changes in the body, and one of the most noticeable signs is a change in pupil size. When someone uses certain drugs, their pupils may become very small and constricted, a condition called miosis or pinpoint pupils. This physical symptom can be one way to recognize that someone may be battling drug abuse. Knowing which drugs cause pinpoint pupils can help you identify if a loved one is using and may need help. Being able to recognize these warning signs is an important first step toward getting someone the treatment they need.

Pinpoint pupils are not always easy to spot, but they are a real indicator of drug use. If you notice this sign in someone you care about, along with other behavioral or physical changes, it may be time to have a conversation about their substance use.

Which Drugs Make Eyes Pinpoint?

There are several drugs, both illicit and prescription, that may cause pupils to pinpoint.

Prescription Opioids

Narcotics such as prescription opioids are commonly given to people to relieve chronic pain from illnesses or injuries. Opioids are also highly addictive, and account for dozens of overdose deaths every day.

Commonly abused prescription opiates include:

• fentanyl drugs
• morphine painkillers
• codeine drugs
• methadone drugs
• tramadol drugs
• oxycodone (OxyContin) medications
• Vicodin (hydrocodone) drugs

Small pupils may be a sign of misusing prescription opioids, which may require addiction treatment services.

Heroin

Heroin is a powerful opioid drug that, when used, will cause feelings of intense euphoria. Heroin is often sold on the street in powder form or in a tar-like substance called black tar heroin. When someone uses heroin, they may have drooping eyelids and their pupils will constrict due to the way heroin use affects the way the eye reacts to light. Other signs of heroin use may include slurred speech, sleepiness, mood swings, sensitivity to pain, and “track marks” on the arms from needle injection.

Long-term heroin use may lead to addiction and other potentially life-threatening side effects and withdrawal symptoms.

What Causes Pinpoint Pupils?

The primary cause of constricted pupils is light. Pupils will change size depending on how much light is entering the eyes. In bright light environments, pupils will become smaller so the eye does not get exposed to too much light. In darkened environments, pupils will enlarge, or dilate, to let more light into the eyes. Another reason pupils may constrict is from the body’s parasympathetic and sympathetic nervous system. This is also known as the fight or flight response.

If the central nervous system is stimulated from a potential threat, the parasympathetic system may cause the pupils to shrink in size.

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Other Reasons People May Have Pinpoint Pupils

While opioid use is an indicator for pinpoint pupils, there are several other reasons that pupils may constrict due to injury or the use of other prescription medications.

Overdose

Drug overdose occurs when somebody takes too much of a substance over a short period of time. One of the common symptoms of overdose is changes in pupil size, accompanied with other reactions such as vomiting, seizures, or confusion. Substances that may cause overdose include opioids, methamphetamine, benzodiazepines, mescaline, Ketamine, PCP, and other stimulants or amphetamines.

Blood Pressure Medications

Certain blood pressure medications used to treat hypertension, or high blood pressure, are known to cause pinpoint pupils. These drugs are given by prescription and are non-addictive.

Head Or Brain Injury

When someone injures their head or suffers a concussion, their pupils may constrict due to the parasympathetic response to the injury or other complications.

Other Illicit Drugs

While reactions will differ between people, other drugs that may cause pupil constriction and abnormal eye movements include Clonidine, inhalants, and hallucinogens such as psilocybin, LSD, MDMA (ecstasy), and more.

Can Pinpoint Pupils Cause Eye Damage?

Pupil constriction itself doesn’t directly damage the eyes, but the drug use causing it can. Long-term opioid use has been linked to blurred vision, increased sensitivity to light, and involuntary eye movements known as nystagmus. People who inject drugs face an even higher risk of serious eye infections, including endophthalmitis, which is a severe infection inside the eye that can cause permanent vision loss if not treated quickly.

In rare but serious cases, certain substances have been linked to reduced blood flow to the retina, which can result in lasting damage to vision. Pinpoint pupils are temporary and resolve once the drug leaves the system, but they’re a visible sign that substances are affecting the body in ways that can’t be seen from the outside. Anyone experiencing persistent vision changes related to drug use should speak with a doctor.

Treatment Options For Substance Use Disorders

If you or someone you care about has drug or alcohol addiction, recovery is possible. Professional treatment programs are available throughout the country and offer all-encompassing support to help people overcome substance use disorders. Whether you’re looking for help for yourself or a loved one, understanding the different types of treatment available can make it easier to find the right program and take the first step toward recovery.

Drug addiction treatment services may include:

• medically monitored detox
• medication-assisted treatment (MAT)
• inpatient treatment
• outpatient treatment
• dual diagnosis treatment for co-occurring mental health disorders
• group therapy
• 12-step recovery groups
• dialectical behavior therapy (DBT)
• individual therapy
• sober living
• aftercare support
• intensive outpatient programs (IOP)
• cognitive behavioral therapy (CBT)

Seeking an evidence-based treatment program for addiction will help you avoid potentially life-threatening withdrawal symptoms and put you on the path to sobriety.

Written by the Addiction Resource Editorial Staff