Crack-Cocaine Induced Keratitis: Case Report

Corneal complications resulting from crack-cocaine smoking  in individuals with no pre-existing risk factors except repeated abuse of crack-cocaine are labeled  ‘‘crack eye syndrome’’ including a spectrum of presentations ranging from diffuse superficial punctuate keratitis to ulcerative.

Ophtalmology emergency department of 20 Aout 1953, university hospital, Casablanca

We report the case of an infectious keratitis as a manifestation of "crack eye syndrome"

A 31-year-old male patient presented with blurred vision and ocular pain in the right eye. The patient has no history of predisposing illness, corneal trauma, surgery or contact lens use but he reported smocking crack. Visual acuity was counting fingers in the right eye and 2/10 in the left one. No eyelid or eyelashes malposition were found.Examination of the right eye showed a large central stromal abscess with no hypopion. Corneal hypoesthesia was noted during cotton-wisp testing. Emprical topical therapy was initiated immediately using fortified ceftazidime  and vancomycin  dosing hourly. Urine toxicology  was positive for cocaine .The results of the corneal cultures demonstrated multi-sensible staphylococcus aureus.

Infectious keratitis is a sight-threatening condition which can frequently be associated with contact lens wear, trauma, surgery, palpebral malpositions, pre-disposing keratopathy or immunodeficiency. In the case of patient presenting  with atypical corneal epithelial defects or ulceration but with no risk factors, the specialist should  look for the possibility of a diagnosis of crack-cocaine keratopathy through a thourough anamnesis.