Tear film breakup time is decreased which is suggestive of unstable tear film. Nicotine has been reported to cause alteration of the conjunctival flora, irritation, redness, dry eye, ocular surface inflammation and meibomian gland dysfunction 18, 19, 20.
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It can affect multiple structures in the body as well as the eye due to chemical toxicity and free radical-related oxidative damage. Early identification can lead to timely preventive measures and abstinence from drug abuse as well as vitamin supplementation 15.Ĭigarette smoking is one of the most common and the most alarming health problem today. Hence, screening of these patients for early detection of toxic optic neuropathy is essential. A pilot study on a group of alcoholic patients reported 13 per cent prevalence of bilateral typical optic neuropathy in males, but about 20-40 per cent of patients had incomplete forms of optic neuropathy with or without visual impairment which was unilateral and caused impaired colour vision 15. The prevalence of toxic optic neuropathy among alcohol addicts might be underestimated. Coexistent use of smoking and alcohol is known to cause tobacco-alcohol amblyopia, the cause of which is hypothesized to be either because of these substances themselves or nutritional deficiency associated with the abuse. Alcohol dependence can be associated with other addictive disorders, among which nicotine dependence is most common in about 80-90 per cent of the patients 14. Intake of alcohol with other abusive agents is also common, and a cocktail of drugs can lead to a multitude of changes in the eye which are often unpredictable ( Fig. Chronic alcoholism changes the conjunctival flora by increased colonization of Staphylococcus aureus bacteria which along with associated dry eye is responsible for higher rates of keratitis in alcoholics 13. Ethanol is detected in tears, and it decreases tear film volume, disturbs tear film structure 10, increases tear hyperosmolarity 11, induces increased expression of inflammatory cytokines 12, and vitamin A deficiency and all these factors combined lead to dry eyes. The mean subfoveal choroidal thickness increases during the first hour after alcohol consumption and decreases during the next two hours 9.Ĭhronic intake of alcohol can cause external ophthalmoplegia (due to thiamine deficiency), toxic amblyopia and age-related macular degeneration (ARMD). Alcohol intoxication can also impair mesopic rod and cone temporal processing pathways 8. Alcohol intake may impair the vision or orientation to visuospatial stimuli due to the various mechanisms. Alcohol intake in short term leads to dilated pupils, slower pupillary reaction, diplopia, night vision disturbances 6, 7, decreased contrast sensitivity, congested eyes, twitching of eyelid (myokymia) due to excessive intake and nystagmus. This review describes some of the ocular effects of commonly abused drugs.Īlcohol abuse is emerging as a major public-health problem in India and more than half of all alcohol drinkers fall into the category of hazardous drinking 5. Recognition of subtle ophthalmic signs in a patient who does not have the whole manifestation of symptoms due to a particular drug abuse can be beneficial. Often such patients present to the emergency team or to a physician in the acute setting. Several drugs which dilate the pupil can lead to angle-closure glaucoma in predisposed patients with narrow angles 4. Spread of microorganisms (including Candida, Aspergillus, Bacillus, Staphylococcus, Pseudomonas, Klebsiella, etc.) to the eye through blood stream due to contaminated needles can lead to endogenous endophthalmitis 2, 3.
Intravenous drug abuse can lead to microemboli in retinal microcirculation leading to retinal ischaemia 2, 3. The changes that can be produced in the eye by toxic drugs range from mild/no symptoms to severe loss of vision and endophthalmitis resulting in a permanent loss of sight.
The routes of administration of these drugs include oral ingestion, smoking, nasal inhalation, intravenous injection, topical application or application to other mucosal surfaces 1. Understanding their adverse effects on the eye can aid in early diagnosis and initiating appropriate treatment. It is important from an ophthalmologist's point of view to have knowledge regarding the effects of these illicit drugs on the eye.
Several of these may have ophthalmic effects. There are numerous illicit drugs or chemicals causing unwanted physiological changes in our body.
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