Eyes and Intoxication: Clues the Eyes Give

The eyes are called “the windows to the soul”. They can also give great clues about health status. Eyes react differently to different substances. In fact, assessing eyes can give clues to intoxication status (and even suggest substances!) in clients. Understanding how to read the eyes of your patients can be a valuable took in your assessment tool kit.

• Assessment is a skill essential to all nurses at every level – from LPN, RN to APRN
• Honing these assessment skills allows you to take in a “big picture” in just a few seconds
• Being purposeful in your assessment will help you and, most importantly, help the patient!

If you have worked in healthcare you know how important looking at the eyes can be and the stories they can tell. Train your mind to be alert to the clues the orbits give you!

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Way to go you! You have already build a solid foundation for your future!

The Eyes Have It

Pupil size and even general redness are important items to note when assessing an individual who may be suffering from an intoxication of a substance.

It is important to:

• Take a look
• Document your findings
• Take appropriate action to alleviate suffering while enhancing wellness for the patient.

A quick evaluation of the orbitals includes the PERLA process. But there is more to consider.

This article outlines more effects of illicit substances on the eyes, if you would like a further, more in-depth review.

Dilated Constricted Pinpoint: What Pupil Size Reveals About Intoxication Status

The first thing most notice when looking at the eyes is the pupil. And for good reason. This large dark spot is pretty hard to miss. LOL.

And it is remarkable in design, able to change shape as needed to protect vision. Pupils also dilate and constrict in response to light, signals in the body (fight or flight response comes to mind) and substances.

Vision clarity can also be impacted by substances.

When a client presents as under the influence, and they either cannot (or will not) tell you what they may have imbibed in, it is important to do some assessments that will lead to differentials and point you in the right direction for more exploration, intervention and treatment.

Dilated Eyes and Intoxication

When the eyes are dilated, the vision can become blurred as more light is let into the eye. Substances known to impact the dilation include:

• Alcohol – also blurred vision, double vision and red eyes
• Amphetamines: blurry vision, nystagmus
• Benzodiazepines: double and/or blurry vision
• Cocaine
• hallucingenens nd simulants
• Hallucigens include Pot, LSD, Mushroom, Acid
• Simulants include: Cocaine, crack, meth
• Antidepressants can cause dilated pupils, as can marijuana and speed

Constricted and Pinpoint Pupils: Eyes and Intoxication

Have you ever seen true pinpoint pupils? There is no mistaking their characteristics on assessment. Substances that can cause the pupils to limit light exposure into the eye by constricting the pupil size down (even to a pinpoint amount) include the following:

• Opioids: oxycodone, heroine (can get to pinpoint), Percocet, Vicodin
• Benzodiazepines: Xanax, vallum
• Barbiturates: tranquilizers and sedatives
• Narcotics can be legal or illegal, can constrict to pinpoint, and include substances such as morphine, heroine, hydrocodone, fentanyl

Red Eyes and Intoxication

General redness of eyes can be caused by marijuana, cocaine /crack, benzodiazepines and depressants like alcohol or sedatives. Marijuana can also cause runny/watery eyes.

Other Eye Characteristics of Substance Intoxication

Other clues the patient may have taken a substance include:

• Methamphetamine: will often have rapid eye movement
• PCP: rapid, involuntary eye movements occur

Eyes and Intoxication Status

Observation of the pupils, the redness or watery quality of the orbitals is not diagnostic for substance intoxication. But assessment of pupils is an important nursing function and can be a great first step in creating a list of differentials for he client. Understanding how the eyes react to different substances (illicit and licit) can help guide the nurse on rapid intervention for the client. For a Nurse Practitioner, swift assessment can lead to decisions on further assessment, testing needs, and interventions that may be needed quickly to help alleviate client suffering and address needs.

Things to consider when assessing the eyes include:

• pupil size
• pupil reaction to light and accommodation
• movement of the eyes
• coloration of the sclera
• discharge

How will you incorporate assessment of the eyes in your care routine with patients?