Ophthalmic complications associated with methamphetamine use disorder

Abstract

Purpose: To describe the devastating ophthalmic sequelae of methamphetamine use disorder in two patients who developed vision loss from ocular complications, including keratitis and endophthalmitis.

Observations: Case 1 is a 26-year-old male with hepatitis C, poorly controlled type 1 diabetes, and chronic methamphetamine use who presented with a corneal ulcer in the left eye. Corneal culture grew Staphylococcus aureus and Streptococcus viridans, prompting antibiotic therapy. Follow-up exam showed peripheral corneal ulceration OD and diffusely vascularized and scarred cornea OS, although nonadherence was reported. Vision eventually worsened to hand motions OD and light perception OS.Case 2 is a 44-year-old woman with hepatitis C, acute myeloid leukemia, dry eye syndrome secondary to chronic graft-versus-host disease (GVHD), and chronic methamphetamine use who presented with a diffuse corneal infiltrate and hypopyon. She underwent emergent corneal transplantation, vitrectomy, and broad-spectrum intravitreal and intravenous antibiotics. Vitreous cultures were positive for Streptococcus pyogenes. However, progressive disease eventually required enucleation despite initial globe salvaging measures.

Conclusions and importance: These two patient cases highlight the risk of vision loss or blindness due to the detrimental effects of chronic methamphetamine use on the eye, including the potential for keratitis and endophthalmitis. Given the increasing prevalence of methamphetamine use disorder in the United States, further understanding of these toxicities and preventive strategies are needed.

Keywords: Amphetamine; Endophthalmitis; Keratitis; Methamphetamine; Methamphetamine ulcer; Methamphetamine-induced keratitis.

Fig. 1

Case 1 on presentation and at follow-up. (A) External photograph of patient on presentation highlights hypotrichosis of the right eyelid. (B) External photograph showing madarosis of the left eyelid. There is erythema involving the superior and inferior eyelids and cicatricial ectropion of the lower eyelid. (C) At follow-up, slit-lamp photograph of the right eye shows conjunctival injection and a 3.5 mm epithelial defect with scarring. (D) At follow-up, slit-lamp photograph of the left eye shows a corneal opacity with scarring and neovascularization.

Fig. 2

Case 2 on presentation and following keratoplasty & vitrectomy. (A) External photograph of the left eye shows diffuse conjunctival injection, diffuse necrotic-appearing corneal infiltrate with central ulceration, and a 2.5 mm central, curvilinear area of uveal exposure. The anterior chamber is poorly visible. The patient underwent a therapeutic penetrating keratoplasty and anterior vitrectomy with intravitreal antibiotics. (B) Postoperatively, there is diffuse conjunctival injection and purulent material in the anterior chamber, along with diffuse periorbital edema. There is no view of the anterior chamber or posterior segment.