What Are Heroin Eyes?

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Since 1999, heroin overdoses have risen by 571 percent. The 13,165 deaths involving heroin reported by The National Institute on Drug Abuse in 2020 may be down from the year prior, but it is up tremendously from the 1,960 reported in 1999. This astonishing 20-year increase is an illustration of the massive impact heroin use has had on our society and the role it plays in the opioid epidemic across the country. That is why understanding the signs of addiction in a loved one is incredibly important. Warning signs and red flags can range from finding drug paraphernalia to physical effects like “heroin eyes.”

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Physical Signs of Heroin Use

While finding drug paraphernalia may be a red flag for heroin use, there are several other ways to tell that someone is struggling with addiction. Many telltale signs of heroin use are physical and, if not realized, can be easily overlooked. Users can exhibit many different red flags such as:

  • Slowed Breathing.
  • Flushed Skin.
  • Runny Nose.
  • Scabs from intense scratching.
  • Slurred speech.
  • Weigh loss.
  • Needle tracks.
  • Scarring.

When it comes to the eyes, however, the signs differ from what many traditionally associate with drug use. It is one of the main reasons why understanding “heroin eyes” is so important.

Does Heroin Use Cause Eye Dilation?

Marijuana, Cocaine, and other amphetamine use can all cause a person’s pupils to become larger and more open. This dilation, referred to as mydriasis, is typically associated with all drug use, but it’s not something caused by heroin or other opiates. Realizing that fact can make the difference between noticing heroin addiction in a loved one and missing it. For many, the general lack of knowledge over this one key fact can cause an overdose to go unnoticed and prove fatal for the user.

What Do Heroin Eyes Look Like?

There is one major difference between the eyes of an opiate user and those of someone on other drugs. The lack of dilation can cause those with misinformation to assume that a near-fatal moment isn’t an emergency. Rather than exhibiting large pupils, a heroin user’s pupils are actually the opposite. This, along with other telling signs in the eyes, can be indications of opiate use. These include:

  • Pinpoint Pupils —The opposite of dilation, pinpoint pupils are a decrease in the size of the black part of the eye. The user’s pupils can appear very small and resemble “pinpoints”.
  • Dark Rims Under Eyes —Commonly referred to as “bags under the eyes”, these dark circles are associated with fatigue, but can also be hyperpigmentation. In heroin users, this change in skin color is due to the blood vessels around the eye being constricted by the drug.
  • Bloodshot eyes — This reddish irritation is commonly seen in those with allergies, colds, or a lack of sleep. It is also a side effect of heroin use.

What Causes Heroin Eyes?

Opiates, like heroin, constrict pupils by attaching themselves to opioid receptors in the user’s brain. It alters their nervous system, causing it to release dopamine into the bloodstream. This is what causes the “rush” that leads to addiction and the sense of euphoria that is often chased through escalating usage.

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What Other Drugs Cause Heroin Eyes?

Heroin eyes are a common effect of all opiate use. Drugs that can lead to this physical feature include:

  • Morphine.
  • Heroin.
  • Meperidine.
  • Methadone.
  • Hydrocodone.
  • Oxycodone.
  • Fentanyl.
  • Pentazocine.
  • Other prescription opioids.

Can Heroin Use Cause Eye Infections?

Severe eye infections are seen as a byproduct of heroin addiction. A study by JAMA Ophthalmology found that hospitalizations for endogenous endophthalmitis, a rare infection of the eye, rose by 400 percent between 2003 and 2016 among those with a history of intravenous drug use. This time frame coincides with regulations aimed to decrease opioid prescriptions, which led many to street drugs like heroin.

While endogenous endophthalmitis is rare among the overall population, it has been a consistent issue in the opioid crisis. It can lead to many health issues including blindness.

Signs Of Heroin Overdose

Knowing what heroin eyes look like is important because, in the case of an overdose, a lack of knowledge can be fatal. A person who is overdosing on heroin (or any opiates) will display signs that include:

  • Loss of consciousness.
  • Inability to be woken up from sleep.
  • Going limp.
  • Gurgling and choking sounds.
  • Drop in blood pressure.
  • Slow pulse.
  • Pale, blue, or cold skin.
  • Blue tint on fingertips or lips.
  • Shallow breathing.
  • Absence of breathing.
  • Pinpoint pupils.
  • Discolored tongue.

It is not uncommon for someone who is overdosing on heroin to suddenly fall asleep standing up or in the middle of while speaking. For a user who is not active, the rolling of the head and eyes is another common flag. Knowing what to look for can make all the difference in preventing and treating death for a user.

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Guardian Recovery can guide users through addiction and into a new life through compassionate and caring treatment. If treated, heroin addiction is not the end. It is a chance to recover, persevere, and find inner strength. Our programs help those suffering from heroin addiction find that strength and embrace stability. For someone looking for help, it’s never too late. To find out more about our focused and individualized program of heroin addiction recovery, contact Guardian today.


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Disclaimer: Does not guarantee specific treatment outcomes, as individual results may vary. Our services are not a substitute for professional medical advice or diagnosis; please consult a qualified healthcare provider for such matters.

  1. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates
  2. https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2772574

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Reviewed professionally for accuracy by:

Ryan Soave


Ryan Soave brings deep experience as a Licensed Mental Health Counselor, certified trauma therapist, program developer, and research consultant for Huberman Lab at Stanford University Department of Neurobiology. Post-graduation from Wake Forest University, Ryan quickly discovered his acumen for the business world. After almost a decade of successful entrepreneurship and world traveling, he encountered a wave of personal and spiritual challenges; he felt a calling for something more. Ryan returned to school and completed his Master’s Degree in Mental Health Counseling. When he started working with those suffering from addiction and PTSD, he found his passion. He has never looked back.

Written by:

Cayla Clark

Cayla Clark

Cayla Clark grew up in Santa Barbara, CA and graduated from UCLA with a degree in playwriting. Since then she has been writing on addiction recovery and psychology full-time, and has found a home as part of the Guardian Recovery team.

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