Ulcerative keratitis associated with crack-cocaine abuse

Cocaine hydrochloride (C(17)H(21)NO(4)) is a powerful neuro-stimulatory alkaloid salt which has been abused by many cultures for thousands of years. Crack-cocaine, a derivative of cocaine, has gained notoriety for giving a quick "high" at a relatively lower cost. Crack-cocaine exposure has been reported to cause corneal disturbances ranging from subtle superficial punctuate keratitis to perforation.

A 42-year-old African-American female presented complaining of mucopurulent discharge and pain in her left eye for a month. No history of trauma, contact lens wear or surgery was elicited and she admitted to chronic polysubstance abuse. A deep, paracentral stromal ulcer was present in the left cornea. The patient was hospitalized for culturing and empiric topical therapy. Toxicology screens proved positive for cocaine and heroine. Initial response to treatment was promising yet the patient discharged herself against medical advice and was lost to follow-up. Cultures were positive for Candida albicans.

Practitioners should be familiar with the toxic effects that crack-cocaine abuse may have on ocular tissues, particularly the cornea. This case demonstrated the value of hospitalization, toxicology screenings and cultures in the management of the atypical keratopathy associated with substance abuse, specifically that of crack cocaine use. Corneal epithelial disruption and stromal ulceration without a history of contact lens wear, trauma, surgery, predisposing keratopathy or immunodeficiency warrants thorough investigation of patient social habits, including substance abuse.