PTOSIS, CONVERGENCE DISORDER AND HEROIN

Drug abuse is a widespread phenomenon which affects all levels of society. General practitioners and primary care physicians are regularly being called upon to see drug users in everyday clinical practice, and are increasingly expected to identify, treat and monitor drug abuse problems. The eye is closely connected to the central nervous system. It responds immediately to nervous stimuli including those induced by drugs. Drug effects on the eye are seen within minutes of use well before the drug could be detected in body fluids. Because of this sensitivity, eye examination in suspected individuals could provide useful diagnostic clues to the treating physician. Many eye complications have been reported in drug users.1,2 These include ptosis, abnormal pupil size, non-reactivity of the pupil to light, diplopia, nystagmus, non-convergence and increased lacrymation. All the major abused drugs including cocaine, marijuana, amphetamine, phencyclidine, heroin, and alcohol produce eye signs. The exact incidence and prevalence is not known. There have been no recent reports of drug-induced eye disorders. A case of unilateral ptosis with inability to converge both eyes on a near object is being reported in an IV drug user. He was admitted to Al Amal Hospital in Jeddah, Saudi Arabia, for management of heroin withdrawals in October 1998. The hospital specializes in the treatment of drug addiction