Cocaine Eyes: What is it?

Cocaine eyes are a common side effect of cocaine use. It includes pupil dilation due to the stimulating effects of cocaine. This results in your eyes being extra sensitive to light as your pupils are so enlarged. Having red and bloodshot eyes, as well as unfocused and irregular movements of the eyes, is also considered a symptom of cocaine eyes.

Cocaine

Cocaine is an addictive stimulant made from the leaves of the South American coca plant.[1] There are two forms of cocaine:

• Water-soluble hydrochloride salt which is injected or snorted.
• Water-insoluble cocaine base, which is cocaine that has been processed with water and either ammonia or sodium bicarbonate to create a substance that can be smoked. This is commonly known as crack.

Cocaine works on the brain by binding to the dopamine transporters and preventing the dopamine from being removed from the synapses. This dopamine accumulation is what causes the feeling of euphoria that is experienced immediately after taking cocaine. [2]

Cocaine is a fast-acting drug. The effects can be felt almost immediately and disappear within a few minutes to an hour.[3] The faster the drug is absorbed into the body, the more intense the high, but it will also have a shorter duration. For example, smoking cocaine enters the bloodstream quickly, resulting in a high that lasts five to ten minutes, while snorting cocaine has a slower onset and can last fifteen to thirty minutes.

What is “Cocaine Eyes”

One of the common side effects of cocaine use is dilated pupils. Cocaine’s stimulating effect results in a quick and significant increase in dopamine and norepinephrine by blocking their reuptake, resulting in enlarged pupils.[4]  When pupils are enlarged, they are sensitive to light. Some cocaine users counteract the light sensitivity by wearing sunglasses. Someone wearing sunglasses in situations or occasions where others around them are not may be an indication of cocaine use.

Cocaine smoke can irritate a cocaine user’s eyes and cause the eyes to be red or bloodshot.

As a person’s high from cocaine begins to wear off, their eyes may become unfocused or have irregular patterns of movement.

Cocaine eyes can include enlarged pupils, red or bloodshot eyes, and irregular movement or unfocused eyes.

There is also a “crack cornea,” which is caused by chronic corneal toxicity from crack use.[5]  It can cause mild symptoms such as punctate keratitis (cornea inflammation) to severe symptoms of bilateral infectious ulcers (infections and ulcers in both eyes).

What Other Eye Problems Can Cocaine Cause?

Cocaine use can cause several eye and vision problems, including:[6]

• Mydriasis: abnormal dilation of pupils
• Eyelid retraction: abnormally high resting position of the upper eyelid
• Conjunctival blanching: whitening of the conjunctiva due to compression of blood vessels
• Decrease in corneal sensation: a reduction or absence of sensitivity of the cornea
• Bilateral keratitis: Inflammation in the cornea of both eyes
• Ulcers: these usually occur due to contamination by eye rubbing or unintentionally entering the tear duct when snorting.
• Orbital inflammation: Snorting cocaine can result in inflammation throughout the nasal-orbital cavity. Depending on the severity or complications from the inflammation, it can result in vision loss. Secondary infections can even escalate to a life-threatening level. Inflammation complications can include:
  • Extraocular muscle inflammation
  • Nasolacrimal duct obstruction
  • Orbital apex syndrome
  • Orbital cellulitis
  • Optic neuropathy
  • Optic perineuritis
  • Central retinal vein occlusion

• Retinal Vasculature: Long-term use of cocaine can result in vascular problems in the eye, including
  • Central retinal artery occlusion
  • Cilioretinal artery occlusion
  • Intraretinal bleeding
  • Central Retinal Vein Occlusion (CRVO)
• Other retinal complications include atrophy of inner retinal layers, the formation of new retinal blood vessels, obstructions that can cause hemorrhaging in the eye, retinal detachment, and vision loss.

If cocaine makes direct contact with the cornea, it can act as a topical anesthetic and reduce the blink reflex.

The complications and severity of eye problems from cocaine use are based on the amount used, the frequency of use, and the duration of use. For any of these eye problems to resolve, cocaine use must be stopped to prevent any further irritation and give the eyes time to heal.

Other Symptoms and Signs of Cocaine Use

Short-term effects of cocaine use can include:[7]

• Constricted blood vessels
• Dilated pupils
• Increased body temperature
• Increased heart rate
• High blood pressure
• Restlessness
• Irritability
• Increased anxiety, panic, and paranoia
• Cardiovascular problems: Erratic heart rhythms and heart attacks
• Neurological problems: Headaches, seizures, strokes, and coma
• Gastrointestinal problems: abdominal pain, nausea
• Bizarre, erratic, and violent behavior can appear with high levels of cocaine use
• Death: usually due to heart attack or seizures

Long-term effects of cocaine use can include:[8]

• Damage to the gastrointestinal tract: causing weight loss and malnourishment
• Damage to the cardiovascular system: severe chest pain that feels like a heart attack is a common complaint among long-term cocaine users. Increased risk for stroke, inflammation of the heart that limits its ability to contract, and aortic ruptures.
• Neurological problems: intracerebral hemorrhage, Parkinson’s disease, cognitive impairments (difficulty maintaining attention, poor impulse control, difficulties making decisions, difficulties with motor tasks).

There are also additional long-term effects that are specific to how the person used cocaine.

• Snorting cocaine: nosebleeds, loss of sense of smell, hoarseness, problems swallowing, and chronic runny nose.
• Smoking crack: worsens asthma and causes damage to the lungs
• Injecting cocaine: track marks on arms, increased risk for infectious diseases including HIV and Hepatitis C, allergic reactions to additives in the drug.

Cocaine binging, which is using cocaine repeatedly at higher and higher doses, can cause:[9]

• Irritability
• Restlessness
• Panic attacks
• Paranoia
• Psychosis

Treatment for Cocaine Use

If you or a loved one have been using cocaine and want to stop, there are evidence-based treatments to help with overcoming a cocaine addiction or other substance use disorder. Contingency management, Cognitive-behavioral therapy, and therapeutic communities are all recognized approaches to treating cocaine addiction. These programs are available as inpatient and outpatient services. You and your support system can work together to decide the best treatment option for your needs.  If you are experiencing any visual difficulties that may be linked to cocaine use, you should seek emergency medical attention immediately. Ignoring eye problems can quickly develop into further infections and injuries.