External Compressive Ischemic Orbitopathy following cocaine use

To report a rare case of External Compressive Ischemic Orbitopathy (ECIO), otherwise known as "Saturday Night Retinopathy", following cocaine use, characterized by its distinctive presentation, diagnostic challenges, and management approach.

A 48-year-old female with a history of polysubstance abuse and schizoaffective disorder presented with sudden, painless vision loss in one eye and limitations in extraocular motility. Imaging studies demonstrated diffuse swelling of the extraocular muscles without sinus disease, and toxicology screening confirmed recent cocaine use, supporting a diagnosis of ECIO.

The patient was diagnosed with ECIO following cocaine use and left against medical advice prior to completing intravenous steroid therapy. Subsequent clinic visits showed improved ophthalmoplegia and a small improvement in visual acuity from light perception to hand motion. This case showcases the importance of considering ECIO in patients presenting with vision loss, ophthalmoplegia, and proptosis with a history of substance abuse.