Opiate use & withdrawal

Alison Y Firth, Lecturer in Orthoptics

Research Interests

Anecdotal evidence and case reports suggest that diplopia (double vision) may be a consequence of withdrawal from heroin. In preventing relapse, any disturbing symptoms are of concern. The problem has to be first identified, with causes investigated prior to management options being considered. The effect of different forms of detoxification may influence changes that occur.

The effect of opiates on orthoptic status

Exotropia has been reported following heroin use in 2 patients. Clinical study suggests that the eyes may generally become slightly more divergent at near, but further study is needed to see whether the deviation varies with time for last dose. If the deviation breaks down suppression or diplopia may occur. Following withdrawal, an eso deviation occurs at distance fixation which does not appear to be due to divergence insufficiency (palsy) or 6th nerve palsy. This can lead to intermittent diplopia in a high number of patients, although this usually resolves in the short term. Where the deviation decompensates to a constant manifest strabismus, referral may be sought by the patient. It is not yet known whether this occurrence is as obvious where non-accelerated detox programmes have been undertaken, and further study in this area is planned.

Recent Publications

Firth AY, Pulling S, Carr MP, Beaini AY. Orthoptic status pre and immediately post heroin detoxification. Br J Ophthalmol 2004; 88: in press.

Firth AY, Pulling S, Carr MP, Beaini AY. The eso trend following heroin detoxification. In de Faber JT (Ed). Transactions 27th Meeting European Strab Assoc, Bergen. June 2003. Taylor & Francis, London. (Abstract). 2004: 289.

Firth AY. Heroin withdrawal as a possible cause of acute concomitant esotropia in adults. Eye 2001;15:189-192.

Publications relating to use of Class A drugs

Firth AY. (Editorial). Class A drug abuse – An ophthalmologist´s problem? Eye 2004; 18: in press.

Firth AY. Ocular sequelae from use of class A and B drugs: A review. Br&Ir Orthopt J 2004; 61 (in press).