Eye Examination Signs of Chemical Dependency

Aka: Eye Examination Signs of Chemical Dependency, Substance-Induced Eye Findings

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II. Exam: Observation

  1. Blank stare
  2. Glazing (film over Cornea)
  3. Excessive Lacrimation (Marijuana)
  4. Red Sclera (Marijuana, inhalant)
  5. Walleye or Bug-eye appearance (Exophthalmos)
    1. Ptosis (Heroin)
    2. Swelling of Eyelids (Phencyclidine or Marijuana)
    3. Retracted upper lid (Phencyclidine)

III. Exam: Pupil size and response

  1. Mydriasis (Pupil Dilation)
    1. Sympathomimetics (Amphetamine, Cocaine)
    2. Anticholinergic Toxicity (e.g. Antihistamines)
    3. Hallucinogens (Ketamine, PCP)
  2. Miosis (Pupil Constriction)
    1. Opioids (e.g. Heroin, Morphine)
    2. Sedative-Hypnotics (e.g. Benzodiazepines)
    3. Cholinergic Toxicity
  3. Slow, delayed, sluggish or absent pupil response
    1. Heroin
    2. Alcohol
    3. Benzodiazepine
    4. Cocaine
    5. Amphetamine

IV. Exam: Abnormal Extraocular Movements

  1. Fails to hold gaze
  2. Nystagmus
    1. Phencyclidine (PCP) - Vertical Nystagmus may occur
    2. Alcohol
    3. Benzodiazepine
    4. Marijuana
  3. Abnormal Convergence (unable to hold Crossed Eyes)
    1. Alcohol
    2. Benzodiazepines

V. Exam: Abnormal Corneal Reflex (Decreased rate of blinking)

  1. Heroin
  2. Cocaine
  3. Amphetamine
  4. Phencyclidine (PCP)

VI. Exam: Abnormal Retinal Exam

  1. Talc Retinopathy (talc used to cut IV drugs)
    1. Peri-Macular vessels show white retractile spots

VII. Exam: Corneal defects

  1. Keratopathy or Corneal Ulcers
    1. Associated with crack Cocaine smoking
    2. Sachs (1993) Ophthalmology 100:187-91 [PubMed]

VIII. Contributors

  1. Paul Rock, OD at Outer Banks Eye Care
    1. http://www.obeyecare.com/eyelinks.html

IX. Reference

  1. Tennant (1988) Postgrad Med 84:109-114 [PubMed]

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