Vision health perspectives on Breaking Bad: Ophthalmic sequelae of methamphetamine use disorder

Abstract

Methamphetamine use has become a rampant public health issue that not only causes devastating consequences to the user but also poses a burden to surrounding communities. A spectrum of ophthalmic sequelae is associated with methamphetamine use and includes episcleritis, scleritis, corneal ulceration, panophthalmitis, endophthalmitis, retinal vasculitis, and retinopathy. In many instances, prompt recognition of the condition and associated infectious process and early initiation of antimicrobial therapy are crucial steps to preventing vision loss. In this review, we summarize the reported ocular complications that may result from methamphetamine use in addition to several postulated mechanisms regarding the ocular toxicity of methamphetamine. The increasing prevalence of methamphetamine use as a public health threat highlights the need for continued investigation of this ophthalmologic issue.

Keywords: keratitis; methamphetamine; neurotoxicity; ocular injury; retinopathy; vision loss.

FIGURE 1

Photographic features and imaging findings of a patient with methamphetamine associated keratitis. (A) External photograph of eyes closed show bilateral lagophthalmos, erythema, and lid thickening. There is hypotrichosis of the right eyelid and madarosis of the left eyelid. (B) External photograph of eyes open show conjunctival hemorrhage and diffuse corneal edema greater in the left than in the right eye, perilimbal injection in the right eye, and subconjunctival hemorrhage in the left eye. (C) Slit lamp photograph of the right eye shows residual corneal ulceration with thickened margins and area of desiccation (yellow arrows). (D) Pentacam image of the right eye shows central thinning in the region of ulceration compared to peripheral cornea.