Author: Charles Frank

What’s Normal Pupil Size and When Do Pupils Change?

A qualified healthcare professional, such as a doctor, psychiatrist, psychologist, or nurse, can assess the individual and develop a treatment plan to suit their needs. Although opioid use disorder can cause serious health and social problems, treatment and recovery are possible. Drug rehabilitation programs can help a person withdraw from the drug, overcome any personal issues that might motivate drug use, and get their life back on track. Although each person’s experience with drug misuse is unique, some general signs and indicators may be present in someone who has an opioid use disorder.

For example, stopping a medication that is causing the pupils to enlarge or having surgery to fix an injury. During a comprehensive eye exam, an optometrist or ophthalmologist may put drops in a patient’s eyes to make their pupils dilate. Dilated pupils that don’t turn back to their regular size, however, are not normal.

This article explores how opioids affect the pupils, the impact on long-term eye health, and how to get help for opioid misuse. Opioid drugs come from the poppy plant and act on the brain to provide pain relief. They include prescription medications, such as those containing oxycodone (OxyContin) and hydrocodone (Vicodin), as well as codeine, morphine, and some illegal drugs, such as heroin. This is when the black part at the center of the eye gets smaller, reducing the amount of light that gets inside.

Constricting Your Pupils

Many things can make your pupils dilate (get larger), but few things can make them constrict (get smaller). In some cases, constricted pupils could be a side effect of opioid use. If your pupils dilate after taking prescription medication, contact your doctor or pharmacist. You should seek treatment if you notice that your pupils are dilated and you can’t explain why. When your pupils are dilated, they’re slower to react to lighting changes. As a result, your eyes will be more sensitive to bright light.

However, it’s also possible for the pupils to dilate, or get bigger, if the eye is injured or affected by a medical condition. Some of these are placed in the eye for the purpose of dilating (enlarging) the pupils as part of an eye examination or a surgical eye procedure. Many medications have the potential to cause changes in pupil size or anisocoria as a side effect.

Babies with anisocoria should have an initial physical examination to determine whether a serious cause needs to be addressed. If your pupils are permanently dilated, you might be able to get special contact lenses that can make your eyes look more normal. Constricted pupils aren’t necessarily a sign that someone’s using opioids. It’s also worth remembering that opioids are prescribed for certain medical concerns, and someone may have constricted pupils if they’re taking opioids as prescribed. They are usually equal in size, but some people are born with unequal pupils. Treating dilated pupils means figuring out what’s causing them to be dilated and addressing the underlying problem.

In addition to medications, some recreational drugs may also cause changes in pupil size. For example, using alcohol, marijuana, or cocaine can cause dilated pupils, and opiates can cause pupillary constriction or dilation. These effects are usually symmetrical, but they may be unequal. Your pupils (the black circle in the middle of your eye) usually change size in response to light.

What Medications Can Cause Unequal Pupils?

If you’re concerned about someone’s opioid use, a non-judgemental, honest conversation can be helpful. More specifically, opioids impact the parasympathetic part of the automatic nervous system. This region responds automatically to stimuli rather than voluntarily and works to slow down bodily functions. It controls the sphincter muscle in the iris, which contracts in response to opioids.

Dr. Moawad regularly writes and edits health and career content for medical books and publications. Treatment is not necessarily focused on making the pupils look equal. Instead, the priority of treatment is to manage the underlying condition. You might notice that your pupils are not the same size when you look in the mirror.

Opioid use disorder can lead to serious health consequences, including eye damage, but recovery is possible. If an individual is concerned about opioid use, they should seek medical attention. A doctor can put together a suitable treatment plan and help the individual find sources of support. Pinpoint pupils do not indicate opioid overdose on their own, but if a person has other signs of an overdose, they can help healthcare professionals confirm the diagnosis. Pinpoint-sized pupils can be a sign of opioid use and can also help a healthcare professional confirm a diagnosis of an opioid overdose when they occur with other signs. If you think someone may be experiencing an overdose, call 911 right away.

1. You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment.
2. When you use opioids like oxycodone, heroin, or fentanyl, the sphincter muscles in your pupils contract.
3. Other external factors, such as color and distance, also affect pupil dilation.

Having one or two pupils that stay dilated could be a sign of a serious medical concern, such as glaucoma or a brain condition. The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment. Most people have pupils that are only a couple of millimeters wide and symmetrical (meaning both eyes have the same size pupil).

Increased levels of oxytocin (the “love” or “bonding” hormone) can lead to dilated pupils. Your pupils might get bigger when you’re feeling attraction or have an emotional response to someone or something. It takes about 20 minutes to 30 minutes for the drops to work.

About Normal Pupil Sizes

A small subset, however, naturally have one pupil that’s bigger than the other. The size of your pupils isn’t something you can consciously control. And if you have a dilated pupil, you won’t necessarily feel it (although some people say they feel a tightening in the eye). A fully dilated pupil is typically in the 4 to 8 millimeters in size, while a constricted pupil is in the 2 to 4 mm range. Seeking help is the most critical step on the route to recovery.

How to Treat Unequal Pupils

A 2017 case study presented an example in which a person’s use of hallucinogens may have led to long-term changes in pupil size. However, a single case is not enough to draw any conclusions about the long-term effects of drug use on the eyes. Opioids, including oxycodone, heroin, and fentanyl, are commonly misused drugs that have the opposite effect, causing pupils to constrict (miosis). Your healthcare provider will determine whether you have any visual problems. And they will also define whether you have fixed or reactive pupils and whether either of your pupils is dilated or constricted.

If you notice these signs in someone, call your local emergency number right away. Constricted pupils typically aren’t the only indicator of opioid use. By Heidi Moawad, MDHeidi Moawad is a neurologist and expert in the field of brain health and neurological disorders.

Treatment for Dilated Pupils

Many different eye and medical problems can cause the pupils to be unequal—a condition called anisocoria. Certain medications placed in the eyes can cause the pupils to be different sizes, but the effects should wear off, typically within a few hours. If you develop new anisocoria, it’s important to get medical attention. The diagnostic process involves a detailed eye exam and neurological examination.