Eyes rolling back into the head, especially when linked to drug use, indicates a serious disruption to the central nervous system. This involuntary eye movement signals a significant impact on neurological processes, often pointing to a life-threatening situation.
What Does “Eyes Rolling Back” Indicate?
When someone’s eyes appear to roll back, it represents an involuntary upward deviation or uncontrolled movement of the eyeballs. This phenomenon can occur alongside unconsciousness, unresponsiveness, or during episodes like seizures or fainting spells. While it might sometimes appear as if only the whites of the eyes are visible, this is often an illusion caused by the eyelids drooping downwards while the eyes deviate upwards.
This eye movement is a sign of significant central nervous system (CNS) depression or neurological distress. The CNS, comprising the brain and spinal cord, regulates all bodily functions, including eye movement. When its activity is severely suppressed, the delicate control over eye muscles can be lost, leading to such involuntary actions. This can also manifest as nystagmus, which is uncontrolled, repetitive eye movement.
This symptom is part of a broader set of signs indicating the brain is not functioning as it should due to a lack of oxygen or direct drug effects. It suggests a person’s level of consciousness is severely impaired, and their protective reflexes may be diminished. This involuntary action serves as a visual cue that the individual is in a compromised state, requiring urgent assessment.
Drug Classes Linked to This Symptom
Several drug classes can cause eyes to roll back, mainly by depressing the central nervous system or inducing neurological effects.
Opioids commonly produce this symptom, often with pinpoint pupils, unconsciousness, and severely slowed breathing. Examples include fentanyl, heroin, morphine, and oxycodone, which can cause this state in an overdose.
Sedatives and hypnotics, like benzodiazepines (e.g., Valium, Xanax, Ativan) and barbiturates, also cause CNS depression. Overdoses can lead to excessive sedation, shallow breathing, bluish discoloration, unresponsiveness, and involuntary eye movements. Alcohol, a CNS depressant, can also cause eyes to roll back during severe intoxication or overdose, along with slurred speech and loss of coordination.
Certain antipsychotic medications, especially older “first-generation” neuroleptics like haloperidol, can induce oculogyric crisis (OGC). OGC is a dystonic reaction with involuntary, sustained upward eye deviation. Less commonly, “atypical” or “second-generation” antipsychotics, such as olanzapine and quetiapine, have also been reported to cause OGC.
In severe stimulant overdoses, such as with MDMA (ecstasy), eyes rolling back can occur. This links to serotonergic overstimulation, potentially causing microseizures. Stimulant overdose can also present with overheating, seizures, confusion, and a rapid heartbeat. Other drugs like antiemetics, antidepressants, and anticonvulsants have been associated with oculogyric crisis.
How Drugs Affect Eye Movement
The involuntary eye movements, including the eyes rolling back, result from drugs disrupting the intricate neurological systems that control ocular function. Many substances achieve this by inducing central nervous system (CNS) depression, a state where brain activity slows significantly. This widespread suppression impacts the brain regions responsible for coordinating voluntary eye movements, leading to a loss of control.
Neurotransmitters, the brain’s chemical messengers, are also profoundly affected. For instance, opioids primarily bind to receptors in the brainstem, a region that regulates vital functions including breathing and some eye movements. This interference can disrupt the normal signaling pathways that maintain eye position and movement control.
In cases like oculogyric crisis caused by antipsychotics, the mechanism involves an imbalance in dopamine pathways. These medications block dopamine receptors, leading to a state of reduced dopamine activity in certain brain areas responsible for motor control, which can result in the sustained, involuntary upward gaze. Similarly, sedatives like benzodiazepines enhance the activity of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter. This increased GABA activity contributes to the impairment of eye movement control.
For stimulants, severe overdose can lead to overstimulation of neurotransmitter systems, such as serotonin, which can result in disorganized neurological activity, including microseizures that manifest as involuntary eye movements. The collective impact of these drugs on specific brain regions and neurotransmitter balance underlies the loss of precise eye muscle control.
Recognizing a Medical Emergency
The symptom of eyes rolling back, especially when connected to drug use, is a clear signal of a severe medical emergency that requires immediate intervention. It indicates that the individual’s central nervous system is compromised, potentially leading to life-threatening complications. Prompt action can significantly improve outcomes.
Observing additional symptoms alongside the eye movement can further confirm the seriousness of the situation. These include shallow or absent breathing, unresponsiveness to attempts to rouse them, and a limp body. The person’s lips or fingernails may appear blue or grayish due to lack of oxygen, and gurgling or snoring sounds may indicate an obstructed airway. Seizures, cold and clammy skin, or an inability to wake the person up are also important signs of danger.
If these signs are present, call emergency services immediately. Provide your exact location and state that someone is unresponsive and possibly experiencing an overdose. While waiting for help, remain with the person and try to keep them awake if they are drowsy. If the person is unconscious, gently roll them onto their side into the recovery position to prevent choking on vomit, as this is a significant risk.
For suspected opioid overdoses, administering naloxone (such as Narcan) can be life-saving if available and you are trained to use it. Naloxone is a medication that rapidly reverses the effects of opioids by blocking their receptors in the brain, restoring normal breathing within minutes. Do not attempt to induce vomiting or give the person any other substances, as this can worsen their condition. Staying with the individual until emergency medical personnel arrive is important.