Table of ContentsView AllTable of ContentsSymptomsCausesTreatmentDiagnosisWhen to Seek Medical Care
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Treatment
Diagnosis
When to Seek Medical Care
Pinpoint pupils occur when the pupils, the black centers of the eyes, appear smaller than usual, even under normal lighting conditions. Small pupils can have a number of causes including overuse and overdose of certain drugs, stroke, head injury, and some medical conditions.
Typically,pupilschange size to control the amount of light entering the eye. Bright light causes pupils to constrict and dim light causes them to expand.
Pinpoint pupil occurs when a pupil stays small, even under standard lighting. The medical term is “miosis,” but you may also hear it referred to as constricted pupil. You can have a pinpoint pupil in one or both eyes.
Westend61 / Getty Images
Symptoms of Pinpoint Pupils
The main symptom of pinpoint pupils is a pupil that remains small in all lighting conditions, even in the dark. Other symptoms of pinpoint pupils will vary depending on the cause. However, common symptoms include:
Pinpoint Pupil Causes
There are several common causes of pinpoint pupils including medications and medical conditions.
Drugs and Medication
Several medications and drugs can cause pinpoint pupils, including:
Overuse and overdose of certain drugs, like heroin andopioids, can lead not only to pinpoint pupils, but also a lack of response to light changes.
Barbiturates, a class of depressant drugs, can cause pupil size to shrink. However, unlike true pinpoint pupils that stay small, pupils responding to barbiturates will rhythmically alternate between constriction and dilation. They may also be sluggish to respond.
Accidentally taking too much benzodiazepine may cause constricted pupils as well.Benzodiazepines, or “benzos,” are prescribed for anxiety, panic disorder, seizures, insomnia, and alcohol withdrawal.
Horner’s Syndrome
Horner’s syndromeis a disorder associated with a pinpoint pupil, upper eyelid drooping, and a lack of sweating around the face. The eyeball also may sink into the bony area protecting the eye.
Although Horner’s syndrome can occur at birth, it usually results from an interference with thesympathetic nervesthat connect to the eye.
Atraumatic brain injurymay damage nerves connected to the eyes, resulting in Horner’s syndrome with pinpoint pupils. This can be a result of aconcussionor head injury from an accident.
Cluster Headaches
Cluster headachescause pain on one side of the head. The attacks range from around 15 minutes to three hours and occur every day or nearly every day for weeks or months. If you have cluster headaches, you may have a pinpoint pupil and eyelid drooping (signs of Horner’s syndrome) during an attack.
The pinpoint pupil and eyelid drooping occur on the same side of the head as the cluster headaches. During these attacks, you may also notice tearing, nasal congestion, swelling around the eye, redness of the eye, and ear fullness.
Anterior Uveitis/Iritis
Anterioruveitisis an inflammation of the middle of the eye. It is sometimes callediritisbecause the middle of the eye includes theiris, the colored ring of the eye.
Anterior uveitis may result from eye trauma (injury) or from certain health conditions, such asrheumatoid arthritis. Having a small pupil is one symptom associated with anterior uveitis.
Synechiae
A condition called posteriorsynechiaecan make the pupil look small. Synechiae are adhesions causing different structures of the eye to stick together. Synechiae can be due to uveitis, previous infection, surgery, or trauma.
Stroke
A stroke occurs when there is bleeding in the brain or a lack of blood flow to an area of the brain. It is a medical emergency and requires immediate treatment. The resulting brain damage can lead to weakness on one side of the body, vision changes, speech problems, and more.
Stroke symptomscome on suddenly and include numbness, weakness, confusion, problems with speech, problems with coordination, dizziness, and severe headache.
If thebrainstemis affected, a stroke can affect vision in different ways. Sometimes it causes the pupils to constrict, other times it causes them to dilate. It can also cause rapid eye movement (nystagmus), double vision (diplopia), ptosis, and other vision problems.
Intracerebral Hemorrhage
Poisoning
Certain toxic substances can result in miosis. They can also cause other symptoms affecting multiple systems, including the respiratory, cardiovascular, and gastrointestinal systems.
If you’re exposed to a nerve agent or anorganophosphatepesticide, you may have pinpoint pupil in one or both eyes.Nerve agents that cause constricted pupils include tabun (GA), sarin (BG), soman (GD), and VX.
Argyll Robertson Pupils
Argyll Robertsonpupils are small and irregular pupils. They usually occur in both pupils, but some people may have only one pupil that is affected.
Argyll Robertson pupils are most often associated with an advanced form of syphilis calledneurosyphilis, which is rare in the United States. However, they are also seen in people with diabetes,neurosarcoidosis(sarcoidosisaffecting the nervous system), chronic alcoholism,encephalitis,multiple sclerosis, Lyme disease, andherpes zoster.
How to Treat Pinpoint Pupils
The treatment for pinpoint pupils will actually target the underlying cause, not the pupils specifically.
Aneye examis the most common way an eye doctor can determine the cause of pinpoint pupils. The eye exam may include a review of your medical history, including any drugs and medications you use.
Because the underlying cause of pinpoint pupils may be another condition not associated with your eye health, healthcare providers may use other tests to diagnose the cause of pinpoint pupils. These may include:
When to See a Healthcare Provider
Set an appointment with an eye doctor or other healthcare provider if you notice that you have a pinpoint pupil—in one or both eyes—and are unsure of the cause.
Seek immediate medical care if you experience eye trauma that results in pinpoint pupils.
If recreational drugs and drug misuse are the cause of pinpoint pupils, a healthcare provider can help guide you to additional help and support.
Summary
Pinpoint pupil, medically termed miosis, refers to the black center of the eye appearing smaller than normal regardless of lighting changes. The symptoms that accompany pinpoint pupils will vary based on the underlying cause. They include eye redness and drooping eyelids.
Causes of pinpoint pupils include opioid overuse, Horner’s syndrome, and an eye inflammation called anterior uveitis. Treatment for pinpoint pupils usually focuses on the underlying cause.
If you notice pinpoint pupils in one or both eyes, contact a healthcare provider. They can help determine and treat the underlying cause.
18 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Asnaashari P.Managing miotics and mydriatics. Review of Optometry. 2021.
MedlinePlus.Clonidine.
American Addiction Centers.Signs of drug use in the eye: pupil dilation and redness.
Dhingra D, Kaur S, Ram J.Illicit drugs: effects on eye.Indian J Med Res. 2019;150(3):228-238. doi:10.4103/ijmr.IJMR_1210_17
Journal of Emergency Medical Services.Toxidromes: common poisoning syndromes to know.
National Organization for Rare Disorders.Horner’s syndrome.
MedlinePlus.Cluster headache.
American Optometric Association.Anterior uveitis.
Melgar MY, Buchan J.Managing cataract surgery in patients with small pupils.Community Eye Health. 2019;31(104):84-85.
Centers for Disease Control and Prevention.Signs and symptoms of stroke.
American Academy of Ophthalmology.Ophthalmologic manifestations of brainstem stroke syndromes.
UpToDate.Spontaneous intracerebral hemorrhage: pathogenesis, clinical features, and diagnosis.
Centers for Disease Control and Prevention.Nerve agent and organophosphate pesticide poisoning.
Agency for Toxic Substances and Disease Registry.Medical management guidelines for nerve agents: tabun (GA); sarin (GB); soman (GD); and VX.
American Academy of Ophthalmology.Argyll Robertson pupils.
National Institute on Drug Abuse.Opioids.
American Academy of Ophthalmology.Traumatic Horner syndrome.
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
