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Ulcerative keratitis associated with crack-cocaine abuse
Andrew F Pilon1, Jill Scheiffle
1Illinois College of Optometry, Chicago, IL, USA. apilon@scco.edu
Summary
Crack-cocaine abuse can cause severe corneal damage, including stromal ulcers. Early identification through toxicology and cultures is crucial for managing this atypical keratopathy in substance abuse patients.
Area of Science:
- Ophthalmology
- Toxicology
- Substance Abuse Research
Background:
- Cocaine hydrochloride is a neuro-stimulatory alkaloid with a history of abuse.
- Crack-cocaine, a derivative, offers a rapid, inexpensive high and is linked to corneal issues.
- Reported corneal disturbances range from punctate keratitis to perforation.
Observation:
- A 42-year-old female presented with a month of left eye pain and mucopurulent discharge.
- She had no history of trauma, contact lens wear, or surgery but admitted polysubstance abuse.
- A deep, paracentral stromal ulcer was noted in her left cornea.
Findings:
- Toxicology screens were positive for cocaine and heroine.
- Corneal cultures identified Candida albicans.
- Despite initial positive response to treatment, the patient left against medical advice.
Implications:
- Ophthalmologists must recognize the ocular toxicity of crack-cocaine.
- Hospitalization, toxicology, and cultures are vital for atypical keratopathy management.
- Corneal ulcers without typical risk factors necessitate investigation into substance abuse.
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