title: Heroin and strabismus.
abstract: OBJECTIVE
  We report on a series of patients with acute strabismus related to heroin and methadone intake or withdrawal, discuss possible mechanisms involved in this clinical picture and make recommendations for work-up and referral.
  
  
  METHODS
  Retrospective study.
  
  
  RESULTS
  Five patients presented with acute esotropia within days of heroin withdrawal, and two patients developed exotropia related to heroin or methadone intake. Neurological work-up and neuroimaging was non-contributory in all four patients who were examined.
  
  
  CONCLUSIONS
  Acute esotropia with double vision is a disturbing side effect of heroin withdrawal, and, similarly, acute exotropia may be related to heroin intake. In the absence of focal neurological signs, further work-up is not mandatory. Referral to a specialised orthoptic service is beneficial in offering the patient symptomatic treatment and reassurance, thus supporting successful withdrawal therapy.
authors.affiliation: Department of Ophthalmology, University Hospital Zurich, Switzerland.
authors.forename: F K P
authors.initials: FK
authors.lastname: Sutter
authors.forename: Klara
authors.initials: K
authors.lastname: Landau
mesh_terms: D000328:Adult; D004172:Diplopia / Q000150:complications; D004948:Esotropia / Q000139:chemically induced* / Q000150:complications; D005260:Female; D003932:Heroin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008691:Methadone / Q000009:adverse effects*; D009294:Narcotics / Q000009:adverse effects*; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome
chemical_list: D009294:Narcotics; D003932:Heroin; D008691:Methadone