What Do Heroin Eyes Look Like? Signs, Symptoms, and Long-Term Effects

While most people associate the rise in heroin addiction to the Vietnam war and the flood of the opiate into the United States, it actually arrived on US shores much earlier. The first accounts of heroin use in the US stretch back to the early 1900s, with the drug causing a healthy crisis by 1912.

Today, heroin is still a popular street drug, but its falling behind in popularity to synthetic opioids like fentanyl, and tranquilizers like Xylazine. Still, many users cross over from fentanyl use to heroin when they can’t find the opioid on the street or they need a cheaper fix.

The term “heroin eyes” has no specific origin, but the term seemed to rise out of the “Heroin Chic” look of the 1990s started by supermodel Gia Carangi and coined after the overdose of photographer Davide Sorrenti. The look is characterized by dark circles under the eyes, pale skin, an emaciated frame, and stringy hair.

But that origin story doesn’t have anything to do with the use of the term in a recovery context. In this post we “look” into the meaning of “Heroin Eyes,” from a medical/health perspective.

What Do Heroin Eyes Look Like?

Opiates and opioids tend to turn the users eye bloodshot and lead to inflammation around the eyelids. The inflammation starts out red and deepens into dark—almost black—circles around the eyelids. The eyes may also take on a sunken appearance, giving the impression that the user looks exhausted, all the time.

But besides the physical changes to the appearance of the whites of the eyes and the eyelids, the real change that usually goes unnoticed is the development of “Pinpoint Pupils.” The medical term for this condition is “Miosis.” It’s a dangerous condition with the potential for severe complications that can jeopardize the user’s vision over time.

What Is the Medical Condition Miosis (Pinpoint Pupils)?

Miosis is a medical condition referring to the constriction of the pupils over the iris. Technically, it’s known as “Pupillary Miosis” and occurs when the tiny muscles in the iris tighten around the pupil. The pupils of heroin users who experience miosis look so small that they’re like pin heads lost amongst the colorful background of the iris.

Our pupil’s contract when we expose our eyes to light. The brighter the light, the bigger the contraction, and the smaller the pupil appears. The pupils also contract when we experience activation of the sympathetic nervous system (SNS) and the release of the catecholamine, adrenaline as the SNS activates the “fight-or-flight” response.

When heroin users inject or snort the drug, it causes a similar reaction in the eyes, with the user developing rapid miosis. The effect can last for hours, and since heroin users try as best they can to remain perpetually high, their eyes seem to be locked somewhat permanently in this state of “pinpoint pupils.”

Heroin is an opiate and binds to receptors in the brain, releasing neurotransmitters like serotonin and dopamine that provide the pleasurable experience that draws users to the drug. Essentially, every time a heroin user takes a hit, they’re experiencing pinpoint pupils, and the effects of this condition, while unique, are hard to spot unless you know what you’re looking for.

What Do Pinpoint Pupils Look Like?

Pinpoint pupils look exactly what they sound like. The user’s pupils are tiny, around the size of a pin head. They don’t respond to changes in light conditions in rooms and may get even smaller if the patient steps into the direct sunlight or if a doctor shines a light into their eye to check the pupil and cornea.

The Long-Term Ocular Health Complications of Heroin Use

Long-term heroin users experience changes in their vision and the structure of their eyes. The miosis becomes more severe and more consistent, leading to a near permanent change in the resting size of the pupil.

The bloodshot eye syndrome experienced by the user also becomes near-permanent and the user may experience changes in the color of the iris and the emergence of tiny black dots in the color of the iris. The user appears tired or high all the time, and their condition becomes more notable the deeper they get into their addiction.

Beyond these physical changes, heroin users tend to rub their eyes more than usual, increasing inflammation in the tissues around the eye and increasing infection risk. The user might develop “endophthalmitis,” an infection of the interior cavity of the eye, causing the need for surgery to extract the infected eye.

Heroin Use and Vision Impairment

Long-term use of heroin and opioids has links to several types of vision impairment. Keratitis and corneal ulceration may occur due to the user’s malnutrition and the practice of using contaminated needles in intravenous drug users.

The patient may also develop “Retinal Vascular Occlusive Disease” (ROVD), a condition that eventually leads to total loss of vision and blindness in one or both eyes. The detoxification process in long-term users may also affect eye structure and function.

The patient is at risk of developing “Esodeviation,” where the eyes shift out of alignment and point inward towards the nose. The user may also develop “Ocular Motility Disturbances” that affect the eyes movement and ability to track moving objects.

Heroin Use and Neurological Impairment

Beyond the changes to the structure and function of the eyes and the gradual vision impairment risk to users, chronic users may experience neurological impairments. The user may lose their depth perception and ability to see color.

According to Dr. Andrew Huberman, a leading neurologist from Stanford, the eyes are an external component of the brain. Therefore, changes in the function and structure of the yes affects the brain and the nervous system, leading to many more adverse health effects in users, including changes to their mental health and thought processes.

The Abuse of Heroin and Its Effects on the Face

The eyes are the focal point of the face. When we meet someone, it’s customary in most Western Countries for people to look each other in the eyes for a brief moment as a sign of acknowledgment and mutual respect.

While heroin users experience massive changes to ocular structure and function, they also endure changes to the physical appearance of the face. Users may lose weight as they eat less, and their face may appear gaunt and drawn.

The damage to the liver and the systemic damage to the body shows up on the skin, making it look grainy and less vibrant. It’s common for heroin users to develop signs of premature aging in their face, such as lines and wrinkles.

While these facial changes are already huge and cause for concern, it’s the picking that really changes the addicts look. Heroin makes the skin itch, especially when the user is fiending for a dose. They’ll pick at the itch and won’t even realize they’re doing it. After enough picking, the skin breaks and starts to weep, leaving unsightly sores on the user’s chin, cheeks, and forehead.

Since heroin has a suppressing effect on the immune system, the user finds that the sores on their face resulting from picking take a long time to heal, and they may not heal properly, increasing infection risk and the potential for scarring.

Heroin – Understanding Opioids and Opiates

Many substance abuse articles and people involved in the recovery industry use the terms “opiates” and “opioids” interchangeably. While there’s nothing officially wrong with this practice, it’s technically incorrect, and it’s good for people who don’t understand the difference between the compounds to educate themselves about these drugs.

Both opioids and opiates are narcotics, a class of drugs that interact with the central nervous system and brain, causing pain relief in medical settings. The difference between the two compounds is that opiates derive from natural sources. For example, heroin is a drug refined from poppies. Opioids are synthetic versions of opiates made in a laboratory, such as fentanyl.

As a result, opioids can be thousands of times stronger than heroin or morphine. For instance, fentanyl is, gram for gram, 50 times stronger than heroin. Carfentanil, another opioid, is 5,000 times stronger than heroin, gram for gram.

Here are some examples of common prescription opioids.

• Hydromorphone (Dilaudid®).
• Hydrocodone (Lortab®, Lorcet®, Vicodin®, and Norco®).
• Oxymorphone (Opana®).
• Oxycodone (OxyContin®).

Heroin is more expensive than fentanyl on the street, which is why the U.S. is experiencing an epidemic of this drug. Many street dealers will cut fentanyl into heroin supplies to increase its potency and the dealers profit margins.

Unfortunately, the increased potency also makes overdose risk even greater. Fentanyl being more powerful than heroin means that many users may not respond to emergency treatment and pass away after an overdose.

Symptoms of Heroin Overdose

Few addicts intentionally overdose on heroin. The overdose usually occurs because they have no way of assessing the potency of the drug or whether it’s mixed with fentanyl. The result is a hot dose that’s not what they intended, resulting in a cascading effect through the body that’s starts with a warm flush, and ends in respiratory depression and death.

The user will experience slowing of their heart rate and a drop in blood pressure after consuming too much of the drug. As the opiates (or opioids in the tainted supply) take hold of the nervous system and saturate receptors in the body, the users breathing becomes shallow and slow. Eventually they stop breathing altogether and pass away.

If the user is lucky enough to have the emergency responders arrive at the scene, the EMTs administer Narcan, the brand name for Naloxone, to reverse the overdose. Naloxone is a opioid antagonist which binds to opioid receptors and quickly reverse the overdose. In most instances, Naloxone can bring the patient back to consciousness and have them breathing normally within two to five minutes of administration of the drug.

The issue is that with opioids like fentanyl showing up in the heroin supply, the number of Naloxone doses administered to save the user is constantly on the increase. There are stories where EMTs have used up to five doses to bring the user back from the brink of death.

Naloxone is only effective for a short time, usually 30 to 90 minutes. If the user has a significant dose of fentanyl and isn’t prepared for it, they may be brought around by the administration of Narcan, only to fall back into overdose after the lifesaving drug wears off.

Heroin overdose is hard to assess in users using the typical method of shining a light into the users eyes to check for pupil contraction. This test shows that the brain is still alive and that it’s possible to bring the person back. However, the pinpoint eyes of a long-term user may interfere with this vital medical assessment.

Heroin and Co-Occurring Mental Health Disorders

From the first time users experience a dose of heroin, it’s a life-changing experience that sets them down a dark path of addiction. More than 50% of people with a drug problem have a co-occurring mental health disorder.

It’s common for heroin users to develop depression, despite the drug making them feel euphoric and happy the first few times them use it. But when they end up addicted and their behavior changes, the drug ceases to be fun and becomes a relentless chase to find the next hit.

Addicts who spend years deeply addicted to heroin may develop severe mental health disorder like psychosis, bi-polar, or schizophrenia. That’s why it’s so important to be correctly assessed by medical and psychological professionals before entering recovery.

What Do Heroin Eyes Look Like—Key Takeaways

• “Heroin Eyes” is a term that’s been part of the “heroin Chic” trend since the 1990s.
• “Heroin Eyes” is also a term describing the medical condition “miosis,” commonly known as “pinpoint eyes.”
• Heroin Eyes occur due to the contraction of the pupils, caused by the activation of the sympathetic nervous system.
• Heroin Eyes can cause lasting changes to the structure and function of the eyes.
• Long-term use of heroin can lead to severe ocular health issues, like dangerous infections and even blindness.