Corneal complications associated with the use of crack cocaine

A case series of patients with corneal complications associated with crack cocaine use is presented. Patients had infectious keratitis or sterile epithelial defects.

Entry criteria into this series included the presence of an infectious corneal ulcer or sterile epithelial defect after the patient used crack cocaine routinely. Patients were prospectively identified from July 1, 1989 to June 30, 1991.

Fourteen patients with crack-related corneal problems were identified. In 10 patients with infectious corneal ulcers, both bacterial and fungal organisms were isolated, and patients were treated with appropriate antimicrobial therapy. The group of patients with sterile corneal epithelial defects were seen after they had rubbed their eyes vigorously after crack cocaine use. The epithelial defects were treated and healed without complication.

Crack cocaine users appear to represent a unique subset of young patients predisposed to infectious keratitis and corneal epithelial defects. A number of hypotheses are offered to explain this effect. Both ophthalmologists and the general public should be aware of these severe corneal problems associated with the use of crack cocaine.