Ocular signs of cocaine intoxication in neonates

We examined 13 cocaine-intoxicated neonates, proven by urine assay, by slit lamp and found that most had iris blood vessel abnormalities. Using an iris vascularity scale that ranged from Grade 0 with no visible vessels to Grade 4 with dilated and tortuous vessels, we found that the intoxicated infants had increased grades in the iris periphery and collarette (P less than .02) as compared to 36 control newborns who had no cocaine in their urine. Infants with dilated or tortuous iris vessels were more likely to be intoxicated by cocaine (P less than .01). The presence of dilated or tortuous iris vessels in a neonate should signal the physician to rule out cocaine intoxication.