{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:14:42Z","timestamp":1785402882519,"version":"3.56.0"},"reference-count":47,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Cocaine-induced ocular toxicity is an increasingly acknowledged but often underestimated clinical condition that includes a wide range of eye-related symptoms. The extensive recreational use of cocaine, together with its powerful sympathomimetic and vasoconstrictive effects, leads to various ocular problems that can impact all anatomical components of the eye. This narrative review aims to deliver a thorough and current synthesis of the existing research on the epidemiology, pathophysiology, clinical symptoms, and therapy of cocaine-related ocular illness. Evidence suggests that cocaine-induced ocular damage involves vascular, local toxic, neuronal, and immunological processes. Reported manifestations in the literature include the ocular surface, optic nerve, posterior segment, orbit, and adnexal tissues. Novel imaging techniques have revealed subclinical retinal microvascular changes in chronic users, suggesting a continuum from initial vascular dysregulation to manifest ischemic injury. Notwithstanding increased awareness, the existing evidence is constrained by heterogeneity, small sample sizes, and a prevalence of case reports. A comprehensive understanding of the pathophysiological mechanisms and long-term ocular effects is crucial for enhancing diagnostic precision, directing management, and informing preventive measures. Enhanced multidisciplinary collaboration between ophthalmologists and addiction experts is essential to tackle this intricate and dynamic clinical dilemma.<\/jats:p>","DOI":"10.3390\/diseases14080274","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T08:09:42Z","timestamp":1785398982000},"page":"274","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cocaine-Induced Ocular Toxicity"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1464-2891","authenticated-orcid":false,"given":"Alessandra","family":"Pizzo","sequence":"first","affiliation":[{"name":"Unit\u00e0 Operativa Complessa di Oftalmologia, Azienda Ospedaliera per l\u2019Emergenza \u201cCannizzaro\u201d, 95026 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0999-5545","authenticated-orcid":false,"given":"Marco","family":"Zeppieri","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy"},{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Marano","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa Complessa di Oftalmologia, Azienda Ospedaliera per l\u2019Emergenza \u201cCannizzaro\u201d, 95026 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0458-2699","authenticated-orcid":false,"given":"Alessandro","family":"Vasco","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa Complessa di Oftalmologia, Azienda Ospedaliera per l\u2019Emergenza \u201cCannizzaro\u201d, 95026 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corrado","family":"Pizzo","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa Complessa di Oftalmologia, Azienda Ospedaliera Sant\u2019Elia, 93100 Caltanissetta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5719-0465","authenticated-orcid":false,"given":"Antonio M.","family":"Vicari","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa Complessa di Oftalmologia, Azienda Ospedaliera per l\u2019Emergenza \u201cCannizzaro\u201d, 95026 Catania, Italy"},{"name":"Istituto di Oftalmologia, Universit\u00e0 degli Studi di Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7938-876X","authenticated-orcid":false,"given":"Fabiana","family":"D\u2019Esposito","sequence":"additional","affiliation":[{"name":"Imperial College Ophthalmic Research Group (ICORG) Unit, Imperial College, 153-173 Marylebone Rd., London NW1 5QH, UK"},{"name":"Department of Medicine and Surgery, University of Enna \u201cKore\u201d, Piazza dell\u2019Universit\u00e0, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8424-0068","authenticated-orcid":false,"given":"Caterina","family":"Gagliano","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Enna \u201cKore\u201d, Piazza dell\u2019Universit\u00e0, 94100 Enna, Italy"},{"name":"Mediterranean Foundation \u201cG.B. Morgagni\u201d, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6807-9455","authenticated-orcid":false,"given":"Francesco","family":"Cappellani","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Enna \u201cKore\u201d, Piazza dell\u2019Universit\u00e0, 94100 Enna, Italy"},{"name":"Mediterranean Foundation \u201cG.B. Morgagni\u201d, 95125 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Roque Bravo, R., Faria, A.C., Brito-da-Costa, A.M., Carmo, H., Mlad\u011bnka, P., Dias da Silva, D., Remi\u00e3o, F., and On Behalf of the Oemonom Researchers (2022). Cocaine: An Updated Overview on Chemistry, Detection, Biokinetics, and Pharmacotoxicological Aspects including Abuse Pattern. Toxins, 14.","DOI":"10.3390\/toxins14040278"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/0039-6257(85)90154-7","article-title":"Cocaine\u2019s use in ophthalmology: Our 100-year heritage","volume":"29","author":"Altman","year":"1985","journal-title":"Surv. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1016\/j.survophthal.2025.02.004","article-title":"Ocular manifestations secondary to cocaine abuse","volume":"70","author":"Rickels","year":"2025","journal-title":"Surv. Ophthalmol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1177\/1120672120964756","article-title":"A novel case of ocular cicatricial pemphigoid induced by levamisole-adulterated cocaine","volume":"31","author":"Igwe","year":"2021","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.atherosclerosis.2017.03.019","article-title":"Vascular disease in cocaine addiction","volume":"262","author":"Bachi","year":"2017","journal-title":"Atherosclerosis"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1007\/s00417-015-2938-x","article-title":"Cocaine snorting may induce ocular surface damage through corneal sensitivity impairment","volume":"253","author":"Mantelli","year":"2015","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1001\/jamaophthalmol.2020.0919","article-title":"Bilateral Enlargement of the Foveal Avascular Zone on Optical Coherence Tomography Angiography Associated with Cocaine Use","volume":"138","author":"Fortenbach","year":"2020","journal-title":"JAMA Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1016\/j.ajo.2008.05.037","article-title":"Early retinal vascular abnormalities in African-American cocaine users","volume":"146","author":"Leung","year":"2008","journal-title":"Am. J. Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.psychres.2018.11.058","article-title":"Retinal nerve fiber layer analysis in cocaine users","volume":"271","author":"Gemelli","year":"2019","journal-title":"Psychiatry Res."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Kim, S.T., and Park, T. (2019). Acute and Chronic Effects of Cocaine on Cardiovascular Health. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20030584"},{"key":"ref_11","first-page":"e4700","article-title":"Cocaine-induced Thrombosis: Review of Predisposing Factors, Potential Mechanisms, and Clinical Consequences with a Striking Case Report","volume":"11","author":"Sharma","year":"2019","journal-title":"Cureus"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e141","DOI":"10.1097\/IOP.0000000000002181","article-title":"Posterior Ischemic Optic Neuropathy in the Setting of Cocaine-Induced Orbital and Sinonasal Inflammation","volume":"38","author":"Lin","year":"2022","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Armentano, M., Alisi, L., Visioli, G., Saturno, M.C., Barba, A., Speranzini, A., Albanese, G.M., Gharbiya, M., and Iannetti, L. (2024). Retinal Vascular Complications in Cocaine Abuse: A Case Report and a Literature Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13247838"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"488","DOI":"10.18502\/jovr.v19i4.16559","article-title":"Retinal Artery Occlusion: A Review of Current Management Practices","volume":"19","author":"Yu","year":"2024","journal-title":"J. Ophthalmic Vis. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1038\/sj.eye.6700174","article-title":"Cocaine-associated central retinal artery occlusion in a young man","volume":"16","author":"Michaelides","year":"2002","journal-title":"Eye"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1136\/bjo.2007.119248","article-title":"Cocaine-induced chorioretinal infarction","volume":"92","author":"Rahman","year":"2008","journal-title":"Br. J. Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e239","DOI":"10.1111\/aos.12585","article-title":"Acute macular neuroretinopathy following intranasal use of cocaine","volume":"93","author":"Introini","year":"2015","journal-title":"Acta Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1016\/j.neuroimage.2010.08.045","article-title":"Imaging separation of neuronal from vascular effects of cocaine on rat cortical brain in vivo","volume":"54","author":"Yuan","year":"2011","journal-title":"Neuroimage"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1038\/s42003-022-03877-w","article-title":"Cocaine\u2019s cerebrovascular vasoconstriction is associated with astrocytic Ca2+ increase in mice","volume":"5","author":"Liu","year":"2022","journal-title":"Commun. Biol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1001\/archpsyc.1997.01830200020003","article-title":"Impaired color vision in cocaine-withdrawn patients","volume":"54","author":"Desai","year":"1997","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1017\/S1461145712000624","article-title":"Blue-yellow colour vision impairment and cognitive deficits in occasional and dependent stimulant users","volume":"16","author":"Hulka","year":"2013","journal-title":"Int. J. Neuropsychopharmacol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1038\/sj.eye.6701624","article-title":"Class A drug abuse: An ophthalmologist\u2019s problem?","volume":"19","author":"Firth","year":"2005","journal-title":"Eye"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"101374","DOI":"10.1016\/j.ajoc.2022.101374","article-title":"Bitemporal peripapillary hemorrhages: Toxic-ischemic optic neuropathy caused by ethanol and cocaine abuse","volume":"25","year":"2022","journal-title":"Am. J. Ophthalmol. Case Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1177\/112067210901900533","article-title":"An unusual case of cocaine-induced maculopathy","volume":"19","author":"Ascaso","year":"2009","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3528","DOI":"10.1172\/JCI45557","article-title":"Preclinical assessment of CNS drug action using eye movements in mice","volume":"121","author":"Cahill","year":"2011","journal-title":"J. Clin. Investig."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/S0161-6420(93)31672-6","article-title":"Corneal complications associated with the use of crack cocaine","volume":"100","author":"Sachs","year":"1993","journal-title":"Ophthalmology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1097\/ICO.0b013e3180cfe716","article-title":"Corneal ulcers associated with aerosolized crack cocaine use","volume":"26","author":"Ghosheh","year":"2007","journal-title":"Cornea"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"531","DOI":"10.3122\/jabfm.2012.04.110287","article-title":"Levamisole-adulterated cocaine: A case series","volume":"25","author":"Morris","year":"2012","journal-title":"J. Am. Board Fam. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e11","DOI":"10.1097\/IOP.0000000000002250","article-title":"A Case of Chronic Intranasal Cocaine Abuse Masquerading and Exacerbating Underlying Orbital IgG4-Related Disease","volume":"39","author":"Bruce","year":"2023","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.jchemneu.2017.06.001","article-title":"Cocaine adulteration","volume":"83\u201384","author":"Kudlacek","year":"2017","journal-title":"J. Chem. Neuroanat."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1590\/2237-6089-2017-0143","article-title":"Adulterants in crack cocaine in Brazil","volume":"41","author":"Ribeiro","year":"2019","journal-title":"Trends Psychiatry Psychother."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"110985","DOI":"10.1016\/j.drugalcdep.2023.110985","article-title":"Prevalence of fentanyl in methamphetamine and cocaine samples collected by community-based drug checking services","volume":"252","author":"Wagner","year":"2023","journal-title":"Drug Alcohol Depend."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/0002-9343(94)90033-7","article-title":"Cocaine-associated retinal vascular occlusion: Report of two cases","volume":"97","author":"Sleiman","year":"1994","journal-title":"Am. J. Med."},{"key":"ref_34","first-page":"2379697","article-title":"Internuclear Ophthalmoplegia Secondary to Cocaine Abuse","volume":"2017","author":"Rabin","year":"2017","journal-title":"Case Rep. Ophthalmol. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1076\/stra.9.1.9.706","article-title":"Cocaine abuse, generalized myasthenia, complete external ophthalmoplegia, and pseudotonic pupil","volume":"9","author":"Valmaggia","year":"2001","journal-title":"Strabismus"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e17","DOI":"10.1016\/j.jemermed.2018.09.052","article-title":"Anisocoria from Cocaine Exposure: A Case Report","volume":"56","author":"Iyer","year":"2019","journal-title":"J. Emerg. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1956","DOI":"10.1080\/09273948.2021.1906913","article-title":"Severe Cocaine-Induced Midline Destructive Lesions (CIMDL) Leading to Orbital Apex Syndrome and Peripheral Ulcerative Keratitis","volume":"30","author":"Pascual","year":"2022","journal-title":"Ocul. Immunol. Inflamm."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1080\/01676830.2017.1337178","article-title":"Chronic orbital inflammatory disease and optic neuropathy associated with long-term intranasal cocaine abuse: 2 cases and literature review","volume":"36","author":"Siemerink","year":"2017","journal-title":"Orbit"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.ajem.2005.11.019","article-title":"Severe destructive sinusitis and orbital apex syndrome as a complication of intranasal cocaine abuse","volume":"24","author":"Leibovitch","year":"2006","journal-title":"Am. J. Emerg. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1001\/archopht.117.12.1617","article-title":"Nasolacrimal duct obstruction and orbital cellulitis associated with chronic intranasal cocaine abuse","volume":"117","author":"Alexandrakis","year":"1999","journal-title":"Arch. Ophthalmol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"405","DOI":"10.3109\/01676830.2013.815225","article-title":"Dacryocystitis secondary to intranasal cocaine abuse: A case report and literature review","volume":"32","author":"Allard","year":"2013","journal-title":"Orbit"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1017\/S0022215100143695","article-title":"Acute angle closure glaucoma precipitated by intranasal application of cocaine","volume":"113","author":"Hari","year":"1999","journal-title":"J. Laryngol. Otol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/S0002-9394(14)72071-9","article-title":"Acute angle-closure glaucoma associated with intranasal cocaine abuse","volume":"122","author":"Mitchell","year":"1996","journal-title":"Am. J. Ophthalmol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1136\/bjo.86.11.1312","article-title":"Acute angle closure glaucoma following the use of intranasal cocaine during dacryocystorhinostomy","volume":"86","author":"Wilcsek","year":"2002","journal-title":"Br. J. Ophthalmol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1097\/IJG.0b013e3181f7b134","article-title":"Substance use disorder and the risk of open-angle glaucoma","volume":"20","author":"French","year":"2011","journal-title":"J. Glaucoma"},{"key":"ref_46","unstructured":"Ruia, S., and Tripathy, K. (2023). Fluorescein Angiography, StatPearls Publishing."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1124\/dmd.111.039917","article-title":"Prolonged toxic effects after cocaine challenge in butyrylcholinesterase\/plasma carboxylesterase double knockout mice: A model for butyrylcholinesterase-deficient humans","volume":"39","author":"Duysen","year":"2011","journal-title":"Drug Metab. Dispos."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/8\/274\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T08:43:10Z","timestamp":1785400990000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/8\/274"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,30]]},"references-count":47,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["diseases14080274"],"URL":"https:\/\/doi.org\/10.3390\/diseases14080274","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,30]]}}}