Assessment of pupil size during acute heroin withdrawal in Viet Nam

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Abstract
During the Viet Nam conflict, many soldiers used large amounts of pure heroin. Photographic pupillometry was used to evaluate 10 such heroin users and five controls three times daily for six days after the patients' last heroin dose. Initially, heroin users had constricted pupils that dilated as withdrawal progressed and remained mydriatic thereafter. Stimulation with intense light further constricted the miotic pupils of heroin-intoxicated patients. Pupil diameter exhibited a definite circadian pattern, with increasing size throughout each day both in patients and controls. Results confirm pupil diameter as an excellent differential indicator of heroin intoxication and withdrawal.

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