Heroin withdrawal as a possible cause of acute concomitant esotropia in adults

Purpose To report the possible effects of heroin withdrawal on binocular vision. Methods A case series of patients is presented in whom esotropia developed on cessation of heroin use. Results In each case the esotropia was concomitant and prismatic correction restored binocular single vision. Intermittent spontaneous control occurred in one patient, the deviation resolved in one and one patient was lost to follow-up. Conclusions Heroin withdrawal should be considered as a cause of acute concomitant esotropia. However, an accurate history of other medication is needed to ensure that this is not the cause of decompensation.