heroin and Diplopia

To describe the eye misalignments that occur during heroin use and heroin detoxification and to give an overview of the management of persisting diplopia (double vision) which results from eye misalignment.. A literature review using Medline and the search terms strabismus, heroin and substance withdrawal syndrome is presented. General management of cases presenting to the ophthalmologist and orthoptist with acute acquired concomitant esotropia is described.. A tendency towards a divergence of the visual axes appears to be present in heroin users, although when present it may not always lead to diplopia. Following detoxification intermittent esotropia or constant esotropia (convergence of the visual axes) can occur; if intermittent the angle tends to be small and diplopia present when viewing distance objects. Occlusion of one eye to eliminate the second image could encourage the development of a constant deviation. The deviation is not caused by a cranial nerve palsy. Constant deviations of this type are classified as 'acute acquired concomitant esotropia'. Relief from the diplopia may be gained by prismatic correction, and the deviation may then resolve spontaneously. Botulinum toxin or surgical intervention may be necessary in cases that do not resolve.. Heroin use may lead to intermittent or constant exotropia and withdrawal may result in intermittent or constant esotropia. Awareness of the mechanism causing this may avoid referral to other specialties (e.g. neurology) and awareness of treatment modalities could encourage patients to seek appropriate help for relief of symptoms.

Topics: Acute Disease; Diplopia; Heroin; Heroin Dependence; Humans; Strabismus; Substance Withdrawal Syndrome

To determine whether changes in orthoptic status take place during withdrawal from heroin and/or methadone.. A prospective study of patients, using a repeated measures design, attending a 5 day naltrexone compressed opiate detoxification programme.. 83 patients were seen before detoxification (mean age 27.1 (SD 4.6) years) and 69 after detoxification. The horizontal angle of deviation became less exo/more eso at distance (p<0.001) but no significant change was found at near (p = 0.069). Stereoacuity, visual acuity, and convergence were found to be reduced in the immediate post-detoxification period. Prism fusion range, refractive error, subjective accommodation, and objective accommodation at 33 cm did not reduce but a small decrease was found in objective accommodation at 20 cm.. The eso trend found in these patients may be responsible for the development of acute concomitant esotropia in some patients undergoing heroin detoxification. However, the mechanism for this trend does not appear to be caused by divergence insufficiency or sixth nerve palsy.

Topics: Accommodation, Ocular; Adolescent; Adult; Convergence, Ocular; Diplopia; Eye Movements; Heroin; Heroin Dependence; Humans; Methadone; Naltrexone; Narcotics; Refractive Errors; Vision, Binocular; Visual Acuity

We report on a series of patients with acute strabismus related to heroin and methadone intake or withdrawal, discuss possible mechanisms involved in this clinical picture and make recommendations for work-up and referral.. Retrospective study.. Five patients presented with acute esotropia within days of heroin withdrawal, and two patients developed exotropia related to heroin or methadone intake. Neurological work-up and neuroimaging was non-contributory in all four patients who were examined.. Acute esotropia with double vision is a disturbing side effect of heroin withdrawal, and, similarly, acute exotropia may be related to heroin intake. In the absence of focal neurological signs, further work-up is not mandatory. Referral to a specialised orthoptic service is beneficial in offering the patient symptomatic treatment and reassurance, thus supporting successful withdrawal therapy.

Topics: Adult; Diplopia; Esotropia; Female; Heroin; Humans; Male; Methadone; Narcotics; Retrospective Studies; Substance Withdrawal Syndrome

Topics: Adult; Antipsychotic Agents; Chlorpromazine; Diplopia; Heroin; Humans; Male; Substance Withdrawal Syndrome

Topics: Catecholamines; Cyclizine; Diplopia; Electrocardiography; Fecal Impaction; Headache; Heart Rate; Heroin; Histamine Release; Humans; Hypertension; Lidocaine; Male; Myocardial Infarction; Pentazocine; Pheochromocytoma; Practolol