Related Experiment Video
Updated: Aug 6, 2026
Ex Vivo OCT-Based Multimodal Imaging of Human Donor Eyes for Research into Age-Related Macular Degeneration
Published on: May 26, 2023
Visual Snow-Like Symptoms, Ellipsoid Zone Disruption, and Outer Retinal Pigmentary Changes in a Patient with Chronic
Lily C Farrell1,2, Jose S Pulido1, Yoav J Gutterman3
1Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
Purpose:
To report a novel case of kratom ( Mitragyna speciosa )-associated ocular toxicity presenting with visual snow and ellipsoid zone disruption, expanding the known ophthalmic complications of chronic kratom use.
Methods:
A case report and literature review were performed.
Results:
A 70-year-old man with 4 years of daily kratom use (6.8 g daily) presented with worsening nyctalopia and a visual snow-like phenomenon. OCT showed bilateral ellipsoid zone disruption and peripheral RPE changes. Fundus autofluorescence showed macular hypo-autofluorescence. Indocyanine Green and Fluorescein Angiographies were unremarkable. ERG was also unremarkable. His MRI showed chronic, nonspecific age-related changes. Cutaneous hyperpigmentation was also noted. Urine mitragynine was positive.
Conclusions:
This case raises the possibility that chronic kratom use may be associated with visual snow-like symptoms, ellipsoid zone disruption, and RPE changes. Consider multimodal retinal imaging in chronic users, especially with dermatologic signs. More studies are needed to define kratom's ocular toxicity profile.
