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Orthoptic status before and immediately after heroin detoxification

¹ Academic Unit of Ophthalmology and Orthoptics, University of Sheffield, Sheffield, UK
² Detox 5, Harrogate Clinic, Ripon Road, Harrogate, UK

Correspondence to:
Correspondence to:
Alison Y Firth
Academic Unit of Ophthalmology and Orthoptics, O Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK; a.firth{at}sheffield.ac.uk

Aim: To determine whether changes in orthoptic status take place during withdrawal from heroin and/or methadone.

Method: A prospective study of patients, using a repeated measures design, attending a 5 day naltrexone compressed opiate detoxification programme.

Results: 83 patients were seen before detoxification (mean age 27.1 (SD 4.6) years) and 69 after detoxification. The horizontal angle of deviation became less exo/more eso at distance (p<0.001) but no significant change was found at near (p = 0.069). Stereoacuity, visual acuity, and convergence were found to be reduced in the immediate post-detoxification period. Prism fusion range, refractive error, subjective accommodation, and objective accommodation at 33 cm did not reduce but a small decrease was found in objective accommodation at 20 cm.

Conclusions: The eso trend found in these patients may be responsible for the development of acute concomitant esotropia in some patients undergoing heroin detoxification. However, the mechanism for this trend does not appear to be caused by divergence insufficiency or sixth nerve palsy.

Abbreviations: BVA, binocular visual acuity; MSE, mean spherical equivalent; MW, Mann-Whitney; WSRT, Wilcoxon signed ranks test

Keywords: heroin; methadone; substance withdrawal syndrome; strabismus