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A common sign of nerve agent exposure is pinpoint pupils, which is a condition known as miosis. Nerve agents, such as sarin or VX, work by inhibiting an enzyme called acetylcholinesterase that breaks down acetylcholine in the body. When acetylcholine accumulates, it leads to overstimulation of the muscles, glands, and central nervous system. One of the effects of this overstimulation is constriction of the pupils, resulting in pinpoint pupils.

This symptom is particularly important for identifying nerve agent exposure because it distinguishes it from other conditions that might cause pupils to be dilated, such as certain types of trauma or reactions to other substances. Those experiencing such exposure may also have other symptoms, including excessive salivation, sweating, or respiratory issues, but pinpoint pupils are a hallmark sign that suggests a significant disruption in the nervous system functioning due to nerve agents.