Heroin-Induced Exodeviation Masking a Baseline Decompensated Esophoria

Heroin and other opiate intake have been shown to have various effects on the brain, including the documentation of a small number of cases of strabismus from intake and withdrawal. Prior reports of heroin have focused on its tendency to cause diplopia, especially esodeviation upon withdrawal. The authors describe a 25-year-old woman who developed double vision from a decompensated esophoria where heroin use induced an exodeviation that transiently improved her diplopia. Measurements after acute heroin use confirmed by urinalysis revealed an improvement in her decompensated esophoria, reducing the previously documented esodeviation by more than half.