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Drugs That Cause Dilated Pupils

drugs that dilate pupils

Drugs That Cause Dilated Pupils and Why It Happens

Most people are usually familiar with what dilated pupils are, and chances are you are as well! When you were younger you might have shone a flashlight into one of your eyes and watched your pupil shrink before moving the light away and watching it dilate again.

You might also recall your most recent visit to the eye doctor where your doctor put some special eye drops in your eyes to dilate your pupils. By opening up your pupils, eye doctors can take a better look at your eyes and examine them more closely for any abnormalities.

In regular lighting your eyes also adjust. When you walk into a dark room after being in a light-filled room, it can be difficult to see. However, when you give your eyes time to adjust, the pupils dilate (expand) to take in more light and you can see.

Similarly, when you walk out of a dark theater into a sunny parking lot, you might feel blinded by too much light. That’s because when you’re sitting in a dark theater, your pupils dilate, but the sudden move from a dark theater to a sunny area is faster than your eyes adjust. After a few moments in the parking lot, your eyes soon adjust and you don’t feel as blinded anymore.

These situations are ones that a lot of us are familiar with, but what about other instances that cause dilated pupils?

Did you know that certain drugs can cause dilated pupils? In today’s blog, we’ll explore why pupils dilate, what substances cause dilated pupils, potential risk factors of dilated pupils, and managing dilated pupils.

What Are Pupils and Why Do They Dilate?

Pupils are the black circle in the center of your eye. Pupils shrink (constrict) and grow (dilate) in response to varying light levels. Their function is to let light in and direct that light to your retina, which are the nerves at the back of your eye, allowing you to see.

Pupils constrict and dilate through muscles in your eye that are located in the iris. The iris is the colored ring of your eye. The iris is what people will look at to determine what color eyes you have. For example, people with a blue iris have blue eyes and people with a brown iris have brown eyes. Each iris contains the muscles necessary to manipulate the pupils.

Under normal conditions, pupils are usually the same size. According to healthline, a normal pupil measures approximately 4 to 8 millimeters when fully dilated and 2 to 4 millimeters when constricted.

A Variety of Reasons for Pupil Changes

There are a variety of reasons why pupils dilate or appear to be different sizes that go beyond changes in light levels. These range from everyday occurrences to mental conditions and even substance use.

  • Distance of objects you’re looking at
    • Pupils also naturally dilate or constrict based on distance in addition to light levels. Focusing your gaze on something closer to you will cause your pupils to constrict. Casting your gaze towards something farther away will cause your pupils to grow.
  • Concussions
    • You’ve probably heard of concussions before. Maybe you’ve even experienced one before. They’re especially discussed a lot in the realm of contact sports. A concussion is a brain injury that usually results when a hard impact or blow to the head causes the brain to smack into the skull. This can result in a person’s pupils becoming asymmetrical, with one pupil noticeably larger or smaller than the other.
  • Anisocoria
    • Anisocoria is the name used to describe the condition in which pupils happen to be different sizes that aren’t a result of injury to the head. According to the American Academy of Ophthalmology, 1 in 5 people naturally have anisocoria. Many of these people have absolutely no problems that stem from their pupils being two different sizes.
    • However, we should caution that sometimes, anisocoria can sometimes be a sign that there is a more serious eye problem. See an eye doctor if you are concerned about this condition. The American Academy of Ophthalmology explains that people with anisocoria could have
      • A nervous system problem
      • A history of eye damage
      • A risk of having a stroke
      • An infection
      • Adie’s tonic pupil (a condition in which one pupil doesn’t respond to light as well as the other)
  • Cluster headache
    • A cluster headache refers to a specific kind of very intense headache that affects one very focal point of the face. Typically, cluster headaches take place behind the eye and can be very painful. The name “cluster headache” refers to the multiple headaches that occur within an episode. Some people may experience up to eight headaches in one day. The pupil can shrink throughout the duration of these headaches.
  • Iritis
    • Iritis is a condition in which the iris, the colored ring of your eye, experiences some inflammation. Inflammation can occur for a variety of reasons including infection, trauma, and autoimmune diseases. Because the iris contains the muscles necessary to control the pupil, problems with the iris in cases like iritis can cause abnormally sized pupils.
  • Horner’s syndrome
    • Horner’s syndrome is a condition in which an individual has a disrupted nerve pathway or a nerve pathway that has been damaged. This nerve pathway runs from the brain to the face and eye. Injury to that nerve pathway can cause pupils to constrict.
  • Your emotions
    • It might sound a bit strange, but your emotions can affect how your pupils look! The International Journal of Human-Computer Studies published a 2003 study that found the dilation of pupils as a reaction to emotional stimuli such as laughter or a baby crying.
  • Illicit substance use
    • Illicit substance use is one of the prominent side effects from a variety of different drugs. Substance use can both constrict and dilate pupils depending on the substance. We’ll take a look at which drugs do what in our next section.
  • Prescription medication
    • Although illicit substances get most of the attention when it comes to pupil dilation and constriction, prescription medication or medication that you can get over the counter can also affect the iris’ muscles. The next section will cover which prescription medications can affect pupil dilation or constriction in more detail.

Illicit Substances and Prescription Drugs That Affect Your Pupils

A variety of drugs have the power to affect pupil size because drug interactions in the body often affect neurotransmitters in your brain. Neurotransmitters are chemical messengers in your body. The interactions and messages between neurotransmitters are key in operating your body’s central nervous system. The interactions between neurotransmitters help control your bodily functions and enact proper functions.

Many drugs, due to their chemical makeup and the chemical reactions they cause in your body, can cause neurotransmitters to be affected. Because neurotransmitters play a role in your pupil size, a variety of medications and illicit substances affects the appearance of your pupils.

Prescription and over-the-counter drugs that can affect pupil size include

  • Anticholinergics
    • Blocks acetylcholine, a compound in the central nervous system that functions as a neurotransmitter
  • Anticonvulsants
    • These medications are often prescribed to treat epilepsy and seizures. In order to limit the severity or frequency of epilepsy and seizures, anticonvulsants alter neurotransmitter activity and nerve impulses.
  • Antidepressants
    • Many antidepressant medications target serotonin and norepinephrine. These two are chemical messengers that control many bodily functions.
  • Antihistamines
    • Antihistamines are often used to help relieve the symptoms of a variety of allergies. They work by blocking the immune system’s response to allergy symptoms like sneezing or an itchy or closing throat. For example, Benadryl® is a well-known antihistamine.
  • Benzodiazepines
    • Although they are often associated with substance misuse, benzos can also be legally prescribed. There are, however, some unfortunate cases in which individuals become hooked on benzos and begin to misuse them. Benzos impact a particular neurotransmitter that relaxes muscles.
  • Decongestants
    • Decongestants typically shrink blood vessels in order to address swelling and inflammation.
  • Dopamine precursors
    • Dopamine precursors boost levels of the neurotransmitter dopamine in the body. Since dopamine is responsible for many bodily functions, pupils can also be affected.
  • Mydriatics
    • Mydriatics are also known as the eye drops that dilate your eyes. When you go to the eye doctor or need to undergo a particular eye surgery, these eye drops are used to take a better look in your eyes.
  • Stimulants
    • Prescription stimulants are used in the treatment of attention-deficit/hyperactivity disorder (ADHD). Stimulants are well known for causing pupils to dilate.
  • Selective serotonin reuptake inhibitors (SSRIs)
    • SSRIs are often used in treatment for depression since they boost serotonin. Low levels of serotonin can cause depression, anxiety, and sleep trouble.

Commonly misused drugs that dilate pupils include:

  • Amphetamines
  • Bath salts
  • Benzodiazepines
  • Cocaine (including crack cocaine)
  • Crystal methamphetamine
  • Ecstasy
  • Ketamine
  • LSD
  • MDMA
  • Mescaline

Commonly misused drugs that constrict pupils include:

  • Oxycodone
  • Fentanyl
  • Heroin

Are There Permanent Side Effects To Dilated or Constricted Pupils?

When you experience dilated or constricted pupils as a result of substance use, you might wonder if your pupils could permanently remain in such a state. The good news is that pupils usually return to a normal functioning state after the side effects of drug use have worn off.

You should note, however, that some drugs can cause pupil dilation during the withdrawal period. Opioids in particular can cause pupil dilation during withdrawal.

There are not many long-term studies of the effects of whether consistent drug use can cause permanent changes in pupils. More ongoing research will be able to give a clearer answer in the future.

Managing Your Pupil Dilation: Asking For Help

When your pupils are dilated as a result of drug use or any other reason, they can cause you discomfort. Remember: dilated pupils let in greater amounts of light. When you take in more light, normal light levels like an average sunny or semi-cloudy day can seem overwhelmingly bright to you.

You will probably be very sensitive to any light sources while your pupils are dilated. To help make yourself more comfortable, you can wear protective eye gear to help shield your eyes from light levels.

For example, many people use either photochromic lenses in their glasses or wear sunglasses. Photochromic lenses adjust to the light levels automatically, darkening and lightening in response to sunny or dark environments. Sunglasses, of course, help block glare from the sunlight and can keep your sensitive eyes well protected from the sun’s rays.

If you ever have any major concerns about abnormal pupil sizes, consult with an eye specialist to ensure you remain involved and aware about your health.

At Pathways Recovery, we understand that illicit substance use comes with many side effects and can heavily affect your life or your loved one’s life before you realize how severe everything has become. Our holistic and individualized treatment approach can help you turn your life around. Don’t delay your journey. Call us today at 916-735-8377 to get premier addiction treatment today.

Frequently Asked Questions


Which drugs make your pupils smaller?

Opioids generally make your pupils smaller. Smaller pupils are also known as “pinpoint pupils.” Commonly misused opioids include oxycodone, fentanyl, and heroin.

Can medication cause dilated pupils?

Yes, both prescription, over-the-counter, and illicit drugs can all cause dilated pupils. Drug interactions in the body often affect neurotransmitters in your brain. Neurotransmitters are chemical messengers in your body. The interactions and messages between neurotransmitters are key in operating your body’s central nervous system.

What drugs dilate and constrict pupils?

Drugs that can dilate pupils include: antihistamines, anticonvulsants, anticholinergics, antidepressants, benzodiazepines, decongestants, dopamine precursors, mydriatics, stimulants, selective serotonin reuptake inhibitors, amphetamines, bath salts, cocaine, crystal meth, ecstasy, and ketamine.

Drugs that constrict pupils include: oxycodone, fentanyl, morphine, codeine, and heroin.

Codependency in Recovery

codependency in recovery

Getting Through Recovery With Codependent Relationships

Recovery is a journey that can have ups and downs every day. Each day in recovery is something that requires a patient’s strength and the ability to count on support from caring treatment staff. Perhaps most overlooked is just how important strong, positive relationships with family and friends are in the phase of continued recovery.

We know that relationships with our loved ones may not always be healthy or happy, especially during the turmoil and challenges of recovery. But we believe that engaging in education about the best practices and information in the addiction recovery sphere are important for both patients and loved ones.

Today we’re taking a close look at codependency, including what it is, how it affects recovery, and what to do if you think you’re in a codependent relationship.

What Is Codependency?

Codependency is a particular behavioral condition that affects a relationship. This condition can contribute to an unhealthy relationship that is generally characterized as one-sided and may be emotionally destructive.

A co-dependent relationship can be frequently experienced by individuals struggling with substance use and the loved ones of the individual. Usually, the condition itself will affect family members, friends, and other individuals close to the person struggling with substance use.

Codependency is a relationship in which one party, usually the individual who uses, has many physical and emotional needs, and the other party, a family member or friend, devotes most of their time and energy trying to fulfill those needs. The second party is referred to as the codependent. Oftentimes, the codependent spends so much time and energy assisting the loved one that the codependent’s own life, activities, and relationships suffer in the process.

This behavioral condition can be detrimental to both parties involved in the relationship. The codependent’s individual life will suffer and the loved one might have a more difficult time with recovery and maintaining a life away from destructive, unhealthy behaviors. Usually, a codependent individual is overly attentive and can enable the challenges faced by the loved one, making the recovery journey more complicated.

There are recognizable symptoms of a codependent person. These include:

  • Believing they can care for themselves without any help
  • Low self-esteem
  • Seeking recognition and praise from others
  • Difficulty setting or maintaining healthy boundaries
  • Feeling a need to be a caretaker for others
  • Remaining extremely loyal, even in harmful situations
  • Obsession with relationships, even if an emotional connection is lacking
  • A need to please others and ensure others have a positive opinion of themselves
  • Poor communication
  • Difficulty handling change
  • Often doing more than their share of work/responsibilities

Because of the low self-esteem that codependent individuals have, they may look for some kind of activity to keep themselves engaged and make themselves feel better. When a codependent person takes on the role of caretaker for someone going through addiction, the intentions are good. But eventually, the desire to take care of this person becomes a compulsion.

codependent recoveryCodependent individuals take on this role as a protector and martyr for the other individual. They may cover for or give excuses on the behalf of the people they are taking care of. For example, a husband might make excuses for his alcohol-dependent wife.

These kinds of behaviors often “rescue” the individual with an addiction and allow them to continue on a self-destructive path. In addition, the repeated “rescue attempts” encourage the vulnerable individual to depend more and more on the codependent and the unhelpful style of caretaking.

As we can see, codependency adds another layer of difficulty to the challenges of dealing with addiction and addiction treatment. Codependency can affect both parties on either side of addiction treatment: the individual with a substance use disorder and the close relations of that individual.

In the next section, we will explore in greater depth the negative consequences of codependent relationships on the various groups involved.

Negative Consequences for the Codependent

When a codependent partner is engaged in the codependent relationship with an individual who uses, the risks and negative consequences are increased for both parties. These consequences can take a toll on physical and mental health, as well as strain any external social interactions or relationships.

codependency recoveryThe codependent individual can experience a higher risk of developing an addiction. This addiction could be substance related or it could manifest in behaviors like excessive shopping, gambling, or eating.

A codependent will also become overly devoted to the codependent relationship, thus experiencing a loss of any external relationships. All the codependent partner’s time and energy are devoted to this relationship with a loved one, and any responsibilities or activities that are not a part of this relationship will suffer as a consequence. A codependent may struggle to keep up with other tasks and work outside of the relationship.

Negative Consequences for the Addicted Individual

A codependent relationship can serve as an enabling presence in an addicted individual’s life. This can make treatment more difficult because the codependent may not provide the kind of support needed to obtain effective addiction treatment. Because codependent partners feel compelled to engage in a role as a caretaker, they can subconsciously worry about no longer being needed if an addiction habit is treated.

Attempts to seek treatment and actively engage in the recovery process may be hampered by the codependent partner. This obstacle leaves the addicted individual to continue on without receiving proper treatment for their addiction. Even if accessing treatment is a success, the risk of relapse may be higher due to the codependent relationship.

When an individual struggling with addiction enters into a treatment program, any codependent relationships should be discussed and treated alongside the substance habit. In this way, an individual can have a better recovery process and be more equipped to maintain good habits in the future.

Dealing With Codependency

There are multiple ways to handle codependent relationships. These tactics look for ways to help both parties in the relationship handle a change and evolution to a healthier status.

Get Professional Help With Codependency Recovery

An individual with substance use disorder should bring the concerns of a codependent relationship with them to treatment. Knowing that an individual has experienced this kind of relationship can be very helpful for therapists and staff to know. A treatment plan can be better individualized if behavioral conditions like codependent relationships are openly discussed.

If the case of the codependency is particularly severe, the codependent partner may also wish to consider seeking professional treatment. Mental health specialists can assist the partner in gaining a better sense of self-esteem and work through a variety of social skills that can be helpful in creating healthy relationships.

Setting Appropriate Boundaries

Establishing healthy boundaries is beneficial for both parties in a codependent relationship. Boundaries are key in maintaining a healthy relationship and can help both parties work through the challenges of codependency and addiction.

Healthy boundaries are characterized by the following traits:

  • Naming limits
  • Understanding that having different needs and wants is OK
  • Practicing self-awareness
  • Recognizing one’s individual needs
  • Being assertive and consistent with boundaries
  • Respecting the boundaries of others as well as your own

Is Tough Love an Appropriate Solution?

recovering codependentTough love is sometimes thought of as the opposite of codependency and thus, incorrectly identified as a complete solution to the problem.

There are many different sources and organizations that suggest handing out ultimatums to a loved one with a substance use problem. In order to avoid enabling, these suggestions include backing out of the loved one’s life and refusing to be involved while the addiction habit remains. It may seem like this will surely prevent you from participating in any fashion as an enabler, and it will. However, it’s been observed that individuals in addiction treatment who have healthy, strong support from family and friends have a smoother recovery journey.

Because of how important positive support is in recovery, simply defaulting to the tough love method is not the most beneficial manner of supporting a loved one through addiction. Instead, try a healthy rewards system. You can support your loved one in constructive ways and actions like driving them to a job interview, offering encouragement, and spending quality time with them.

Make sure to also set boundaries as you seek to encourage your loved one. Don’t tolerate any substance use in the house or completely shut them out of your life. With the proper support and positive encouragement, sobriety can be maintained.

Here, at Pathways Recovery, we know that recovery is a process. Part of that process involves educating yourself and your loved ones about addiction and its challenges to transform lives. We can help if you are experiencing a codependent relationship during your recovery. Give us a call today at 916-735-8377.

Codependency Recovery FAQs:

What are the signs of a codependent person?

A codependent person suffers from low-esteem. They often feel compelled to seek praise from others and highly value the opinions of others. They may feel as though they should be a caretaker. If the codependent relationship involves an individual struggling with addiction, the codependent partner may enable the addiction and hamper recovery efforts.

What is a codependent behavior?

Codependent individuals often make excuses for the individual they are the “caretaker” of. For example, a codependent might cover for their partner’s alcohol dependency or pull strings to prevent any consequences for poor performance or behavior.

What causes codependency?

Codependency is a learned behavior. This means that a codependent person learned to behave in this manner by watching and imitating others, usually family members, who were also codependent. This type of behavior can be passed down from different generations.

What is an example of codependency?

If an individual with an addiction misses several days of work, the codependent partner will cover for them with a story or excuses.