Opioids + eye health

Opioid use takes a toll on many of the body’s organs and functions, such as an individual’s heart health and skin. What people don’t always realize is that opioid use disorder (OUD) can also affect eye health. Here’s what you need to know about the short- and long-term effects of opioid use on your eyes’ appearance and function. 

How do opioids affect the eyes?

The eyes are one of the first systems in the body that will react to substance use. This is because blood flow is much higher in the eyes, and substances tend to change how blood moves through the body. 

When opioids are involved, pupils typically constrict (i.e., get smaller, even in low light situations) as the brain is flooded with dopamine, and cardiorespiratory function lowers. The resulting pin-point pupils may be an indicator of recent opioid use, but they don’t necessarily cause any long-term issues. As drowsiness sets in during opioid use, the eyes are also likely to sag as muscle function lessens. Again, this isn’t a sign of a major health issue. 

However, people with OUD (specifically with recurrent, heavy opioid use, especially with injection) are at a much higher risk of developing infections—and the eyes may be an area where they experience the problem. 

Why the effects of opioid use on the eyes are so concerning

Much more concerning than the immediate side effects of opioid use are the dangerous bacterial and fungal infections some opioid users experience. People with OUD may start to lose immune system function, either as a direct or indirect result of misuse, especially injection drug use which carries its own risks. 

Sharing needles to inject drugs, like heroin or fentanyl, makes contamination much more likely. As a result, bloodborne illnesses and infections can spread more easily. These infections can also be introduced into a person’s body if the injection site isn’t properly cleaned, which allows bacteria, contaminants, and fungi on the skin to enter the bloodstream. This is why harm reduction efforts—like needle exchanges or syringe service programs, where people can safely dispose of used needles and acquire sterile ones—are so critical.

Drug-related infections cause many different problems, and endogenous endophthalmitis in the eye is a particularly dangerous one. This infection spreads quickly to the back of the eye, where it can damage the retina and begin spreading into the rest of the eye. Left untreated, this infection can cause blindness. But even with treatment, the damage it causes early on is often sufficient to leave a patient with permanent vision problems. Although endogenous endophthalmitis is rare, it is particularly concerning due to its severity and the fact that it has proliferated among opioid users in the last two decades. 

Early signs of this infection include pain, redness, worsening vision, and ocular inflammation. 

How ophthalmology is adapting to the opioid crisis

It is well-established that the overprescription of opioids for medical use is correlated to opioid misuse at large. Opioids are often prescribed as painkillers to patients who’ve undergone surgeries, even minor ones, and this isn’t limited to one field of medicine. 

Even ophthalmologists are accustomed to prescribing opioids, like oxycodone. However, some eye doctors have begun changing their practice to promote safer uses of opioids for medical reasons and reduce the potential for misuse or the development of dependence. These doctors have found that they can drastically reduce the number of pills that are prescribed after corneal and other eye surgeries without compromising pain management. 

Their research into opioid prescription reduction is ongoing, but it shows that the opioid crisis can at least be partially addressed through better medical practices. A study out of the Kellogg Eye Center at the University of Michigan showed that eye surgeons could prescribe significantly fewer pills after cornea surgery without a negative impact on patients’ pain management. Not only that, but many patients did not use the full amount of medication they were given and achieved ideal pain management outcomes. 

This study was designed in response to institutional and state-level changes in prescribing practices and prescription monitoring requirements. Even though Michigan is only one state, the results point to a way out of the opioid crisis.

Get the support you need to protect your health

The care team at Ophelia helps individuals manage their OUD with telehealth treatment that fits their life, not the other way around. Our individualized approach to treatment helps patients get answers to all their questions and find the resources they need to avoid the negative health outcomes associated with substance use. Schedule a consultation call today to get started.