Orbital infarction during drug abuse: tissues of the globe do not appear to recover function

To describe the features of an orbital infarction syndrome arising after prolonged orbital pressure during drug-induced stupor in young people.

The clinical presentation and course for drug-induced orbital infarction is described, based on a retrospective review of clinical notes and imaging.

Two cases of orbital infarction syndrome, due to prolonged orbital compression caused by sleeping with pressure on the orbit during drug-induced stupor, are described. Both patients presented with very poor vision and mydriasis, marked periorbital swelling with some pain, and complete external ophthalmoplegia. Whilst the orbital changes and eye movements recovered, the affected eyes had persistent wide mydriasis, and remained blind with marked optic atrophy.

With a mechanism analogous to prolonged orbital pressure due to improper head positioning during neurosurgical procedures, drug-users appear to risk developing an orbital infarction syndrome if they rest with prolonged pressure on the orbit during a drug-induced stupor.