Are Their Eyes Always Wide? What Dilated Pupils Could Really Mean
You look someone in the eyes, and something feels off. Their pupils are huge, even though you’re indoors. They seem distant, edgy, or not fully present. Could it just be the lighting—or is something else going on?
At Endless Mountain Behavioral Health Center, we help families across Sayre, Bradford County, and surrounding regions recognize early signs of substance use and withdrawal. One subtle but powerful indicator? Pupil size—especially when it doesn’t match the environment.
But eyes aren’t the only clue. If you’re wondering whether someone might be using drugs—or coming down from them—here’s what to watch for.
What Causes Pupil Dilation?
Pupil dilation (mydriasis) is a natural response to:
- Low lighting
- Intense emotions like fear or excitement
- Certain medications
However, some substances override the brain’s natural response system, leaving the pupils wide even in bright light. This is a red flag—especially when accompanied by behavioral or physical changes.
Drugs That Commonly Cause Dilated Pupils
- Stimulants: Cocaine, methamphetamine, MDMA (Ecstasy), prescription stimulants (Adderall, Ritalin)
- Hallucinogens: LSD, psilocybin (magic mushrooms), mescaline
- Some antidepressants and synthetic drugs
In contrast, opioids like heroin or painkillers often cause constricted or “pinpoint” pupils—so pupil size can also offer clues about what kind of substance is involved.
When Dilated Pupils May Indicate Drug Use
Dilated pupils alone don’t confirm drug use, but paired with other signs, they’re worth noting—especially if:
- The eyes don’t adjust to changes in lighting
- Pupils stay large in bright indoor conditions
- There’s no logical explanation (like medication or eye exams)
- The person shows other behavior or health changes
More Than the Eyes: Other Physical Signs of Substance Use
Movement and Coordination
- Unsteady walking or balance problems
- Jerky or exaggerated body movements
- Restlessness or pacing
- Slurred or pressured speech
Skin and Face
- Flushed face or sweating without activity
- Repetitive facial twitching or jaw clenching
- Nosebleeds (suggesting snorting drugs like cocaine)
- Scabs or sores from picking at the skin
Mouth and Breath
- Dry mouth
- Unusual breath odors (chemical, sour, or sweet)
- Lip chewing or constant licking
Appetite and Sleep
- Staying awake for long periods (common with stimulants)
- “Nodding off” mid-conversation (common with opioids)
- Sudden weight loss or binge eating
How to Tell If Someone Is in Withdrawal
Sometimes, it’s not intoxication—it’s withdrawal. Withdrawal happens when someone dependent on drugs or alcohol stops using abruptly, and their body reacts.
This can happen within hours or days of stopping, depending on the substance.
Common Signs of Withdrawal
From Opioids (e.g., heroin, OxyContin, fentanyl):
- Nausea and vomiting
- Sweating and chills
- Goosebumps
- Watery eyes, runny nose
- Muscle aches and joint pain
- Restlessness or agitation
- Yawning repeatedly
- Insomnia
- Anxiety or panic attacks
From Alcohol:
- Tremors or shaking hands
- Irritability or anxiety
- Sweating and flushed skin
- Headaches
- Nausea or vomiting
- Hallucinations or confusion (in severe cases)
- Risk of seizures (requires medical detox)
From Stimulants (e.g., cocaine, meth):
- Fatigue and excessive sleep
- Depression or suicidal thoughts
- Intense cravings
- Slowed thinking or speech
- Increased appetite
If someone appears very sick, anxious, or agitated without a known illness, and their symptoms seem to come and go over days, they could be experiencing withdrawal.
Behavioral Red Flags That May Accompany Physical Symptoms
- Wearing sunglasses indoors
- Avoiding eye contact
- Extreme mood swings
- Paranoia or irritability
- Sudden isolation from family or friends
- Disinterest in school, work, or hygiene
- Secretive behavior around phones or apps
What to Do If You’re Concerned
You don’t need to know exactly what substance is involved to seek help. If someone shows signs of being under the influence, or you suspect they’re withdrawing, professional treatment is the safest next step.
At Endless Mountain Behavioral Health Center, we offer:
- Medical detox to manage withdrawal symptoms safely and comfortably
- Residential treatment for long-term healing and recovery
- Same-day admissions for individuals in crisis
- Programs that accept PA Medicaid, commercial insurance, and self-pay options
We support individuals and families throughout Sayre, Bradford County, Susquehanna County, Tioga County, and surrounding areas.
It’s Okay to Ask Questions—It Might Save a Life
Eyes might be the first clue. But if you’re also seeing illness, withdrawal symptoms, or behavior that doesn’t make sense, there may be more going on than meets the eye.
The earlier someone gets help, the greater their chances of full recovery. If you’re noticing signs and don’t know where to turn, contact Endless Mountain Behavioral Health Center today.