Key Clinical Message
Methadone-induced strabismus is a rare but potentially serious complication of opioid toxicity. Healthcare providers should be vigilant for uncommon neurological and ocular manifestations in patients presenting with methadone overdose, particularly in opioid-naive individuals. Prompt recognition and appropriate management, including the administration of naloxone and supportive care, are essential to prevent long-term morbidity and mortality associated with methadone toxicity.