Mental Health Book

Chemical Dependency

  • Eye Examination Signs of Chemical Dependency


Eye Examination Signs of Chemical Dependency

Aka: Eye Examination Signs of Chemical Dependency, Substance-Induced Eye Findings
  1. See Also
    1. Chemical Dependency
    2. Substance Abuse Evaluation
  2. 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)
  3. 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
  4. 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
  5. Exam: Abnormal Corneal Reflex (Decreased rate of blinking)
    1. Heroin
    2. Cocaine
    3. Amphetamine
    4. Phencyclidine (PCP)
  6. Exam: Abnormal Retinal Exam
    1. Talc Retinopathy (talc used to cut IV drugs)
      1. Peri-Macular vessels show white retractile spots
  7. Exam: Corneal defects
    1. Keratopathy or Corneal Ulcers
      1. Associated with crack Cocaine smoking
      2. Sachs (1993) Ophthalmology 100:187-91 [PubMed]
  8. Contributors
    1. Paul Rock, OD at Outer Banks Eye Care
  9. Reference
    1. Tennant (1988) Postgrad Med 84:109-114 [PubMed]

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