- Use of opioid drugs, benzodiazepine or miotic drugs
- Hemorrhage in the brain stem
- Horner’s Syndrome
- Exposure to chemicals like organophosphates or nerve agents
- Infections or neurosyphilis
- 1 Factors Causing Pinpoint Pupils
- 2 Symptoms of Pinpoint Pupils
- 3 Treatment for Pinpoint Pupils
- 4 When You Should Seek Medical Help
- 5 Procedure of Diagnosis
- 6 Course of Treatment
Factors Causing Pinpoint Pupils
Opioid Drug UsageOpioid drug use is a common reason for pinpoint pupils. Opioid drugs are psychoactive substances that travel across the blood barrier via the central nervous system and affect your mental processes. Some of the popular opioids derived from the poppy plant are morphine, codeine, fentanyl, methadone, oxycodone, hydrocodone and heroin. Opioid drugs are usually used for medical purposes to control pain. However, these drugs are easily misused, as these drugs can alter the states of perception and consciousness. Pinpoint or constricted pupils are a sign of drug overdose and can alert you to opioid drug usage. Also, with regular abuse of opioids, people develop tolerance to the drug and exhibit pinpoint pupils although they are not overdosing.
Benzodiazepine UsageBenzodiazepine, popularly known by its street name benzos, is also a psychoactive drug. These drugs are usually prescribed for problems such as anxiety, insomnia, panic disorders and seizures. Benzos are not safe for consumption if you’re pregnant. Just like opioid drugs, benzos also affect the nervous system in a similar manner and the usage and overdose of these drugs also cause pinpoint pupils.
Miotic Drugs UsageAny drugs that cause the abnormal constriction of pupils are classified as miotic drugs. Both opioid drugs, as well as, benzodiazepines come under the category of miotic drugs. However, some miotic drugs do not fall under these categories. For instance, carbachol is a miotic drug that is prescribed by ophthalmologists for certain conditions of the eye such as glaucoma. This is usually available in the form of eye drops and its use can cause pinpoint pupils. Other eye drops like pilocarpine, epinephrine, echothiophate and demecarium can also cause pinpoint pupils.
Exposure to Chemicals or Nerve AgentsPinpoint pupils may be caused due to exposure to certain kinds of chemicals such as organophosphates. These chemicals are usually used in the production of pesticides. If you are exposed to organophosphates, the parasympathetic system is overstimulated. If you get too much of exposure to these chemicals, you can suffer from an increase in body fluids, muscle cramps and pinpoint pupils. When such symptoms are seen, you must see a doctor immediately to rule out pesticide poisoning. Exposure to nerve agents that are usually used in chemical warfare such as VX, sarin, tabun and soman also cause pinpoint pupils.
Problems in the BrainPinpoint pupils can be caused due to bleeding occurring from a blood vessel in the brain or intracerebral hemorrhage or due to pontine infarctions. Pontine infarction occurs when the tissue in the pons region of the brain dies due to deficiency of blood supply. Both these conditions can occur due to stroke, illness or traumatic brain injury. If the frontal portion of the brainstem is injured, then the pupils of both eyes will be constricted. If any other part of the brain is injured, then the pupils of both eyes may be of different sizes, one may be constricted, while the other may be dilated. If you notice pinpoint pupils and the person has a previous history of brain trauma or stroke, then you must have the condition checked by the doctor immediately.
InfectionsSometimes, pinpoint pupils are caused by viral or bacterial infections. For example, anterior uveitis is an infection that affects the iris and the middle portion of the eye. This may be caused due to some foreign particle in the eye or due to trauma to the eye. Depending on the kind of infection and its severity, inflammatory adhesions may form between the iris and the lens. These adhesions can cause the tissues in your eye to stick together that makes it very difficult for the pupils to expand and contract normally, thus causing pinpoint pupils.
NeurosyphilisPinpoint pupils are not only caused due to infection in the eye. Pinpoint pupils may be an indication of some other infection like neurosyphilis. For example, if your spinal cord or brain is affected, this changes how your pupils react when exposed to light. Neurosyphilis is caused by the same bacteria that cause syphilis.
Horner’s SyndromeHorner’s syndrome, also known as Horner-Bernard syndrome or oculosympathetic palsy, is a physical disorder that affects the nerve pathway between one side of the face and the brain. Horner’s syndrome may be caused by itself without any determined cause or may be due to a tumor, stroke or spinal cord injury. The classic symptom of this condition is pinpoint pupils along with drooping eyelids. Also, there is reduced perspiration on the affected part of the face. Babies that are born with Horner’s syndrome have one iris that is lighter in color than the other.
Other Causes of Pinpoint PupilsA very common reason for pinpoint pupils is hypertension or high blood pressure that is not controlled. Pinpoint pupils may be caused due to other conditions such as mumps, rubella and rheumatoid arthritis. Other less common causes for pinpoint pupils are: medications like Lomotil prescribed for diarrhea, clonidine for high blood pressure, phenothiazines for psychiatric conditions such as schizophrenia and illicit drugs like mushrooms. Sometimes, even deep sleep can cause you to have pinpoint pupils on waking up.
Symptoms of Pinpoint PupilsPinpoint pupils are not a disease, but a symptom that may give you a clue about what is actually causing the problem.
Opioid Drug UsageIf a person is taking opioids, apart from pinpoint pupils, other symptoms may include nausea and vomiting, sleepiness, lack of alertness, confusion, difficulty in breathing, delirium, etc. The symptoms depend on the amount of drugs taken and the duration of drug intake. In the long run, use of opioids can cause reduced lung function and addiction to opioid drugs can include signs such as:
- Severe cravings for the drug.
- Requiring bigger doses of the drug to get the desired effect.
- Financial problems and trouble at home and at the workplace caused by drug usage.
Intracerebral HemorrhageIf the pinpoint pupils are due to hemorrhage in the brain, you may experience nausea, vomiting and headache and you may also lose consciousness.
Horner’s SyndromeIn the case that the pinpoint pupils are because of Horner’s syndrome, your eyelid may begin to droop and the affected side of the face may have decreased sweating.
InfectionsIf you are suffering from anterior uveitis, other symptoms such as inflammation, redness, light sensitivity and blurred vision may occur, apart from pinpoint pupils.
Chemical ExposurePoisoning caused by pesticides and insecticides can cause other symptoms such as tearing, salivation, vomiting, excessive urination and defecation, and exposure to nerve agents may cause problems like vomiting, tearing, seizures and even coma.
Treatment for Pinpoint PupilsSince pinpoint pupils is not really a disease and is a symptom of a disease, there is no particular treatment for the condition. However, pinpoint pupils can lead you to find the correct diagnosis and guide you in the treatment of the particular problem. In the case of an opioid drug overdose, emergency medical staff can make use of the drug, naloxone that can help to reverse the effects of the opioid overdose, which can even be fatal. The condition of intracerebral hemorrhage may sometimes even need surgical intervention to stop the bleeding. Also, the treatment must include steps to keep the blood pressure of the patient under control. There is no medical treatment available for Horner’s syndrome. However, if the cause of the disease is established and treated, it can get better. Anterior uveitis and other infections can be treated by the use of corticosteroids and topical medications such as ointments and eye drops. Poisoning caused due to insecticide usage can be treated by using the drug, pralidoxime or 2-PAM.
When You Should Seek Medical HelpIf you notice that your pupils are abnormally constricted into pinpoints and you are not really able to understand why, then it is a good idea to see your general physician or your ophthalmologist to get a proper diagnosis and treatment.
Procedure of DiagnosisYour doctor will arrive at the diagnosis of your problem after evaluating the various symptoms and signs and may also ask for a few diagnostic tests to be conducted. If you decide on seeing your ophthalmologist when you notice pinpoint pupils that are not normal, then your doctor will conduct a complete examination of your eye. The doctor may dilate your eyes, so that the inside of the eye can be visually examined. In the case that you decide to see your general physician, then the doctor may conduct some diagnostic tests to identify your problem. You may be asked to get an MRI (magnetic resonance imaging) scan, CT Scan (computerized tomography), X-rays, blood and urine tests and a toxicology screening.
Course of Treatment
Opioid OverdoseOpioid overdose can be life-threatening and can even cause death. Any of the following symptoms indicate opioid overdosing and requires immediate medical attention:
- Pale and clammy face
- Blue or purple colored fingernails
- Limp body
- Gurgling or vomiting
- Heartbeat slowing down
- Difficulty in breathing or labored breathing
- Loss of consciousness
- If the opioid drugs were mixed with other substances and what those substances were.
- Whether you continued breathing or not. If you stopped breathing, then what was the duration that you did not have any oxygen.
- If you suffered an injury that may have caused permanent respiratory or neurological damage.
- If you suffer from any other medical conditions.
- If you continue to use opioid drugs.