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What are Cocaine Eyes?

Several drugs affect the appearance of the eyes, and cocaine is one of them. It can make the eyes look large or dilated, a condition called “cocaine eyes” or “cocaine pupils.”

Cocaine is a strong stimulant drug. It’s also called C, coke, blow, snow, and flake.1 

Cocaine comes in three different forms: 

  1. Hydrochloride salt: A white powder can be snorted or dissolved in water for injection. 
  2. Freebase: Processed from the salt form. Freebase cocaine can be heated and smoked. 
  3. Crack: The rock form that contains impurities. Like the freebase, crack cocaine is heated and smoked.

Whatever the form is, cocaine is an illegal drug in the U.S. It’s a Schedule II drug, which means it can be used for medical purposes but has a high potential for abuse.2

Cocaine users are mostly recreational users. However, around 25% of them already meet the criteria for a ‘cocaine user.’ Cocaine use is common in the U.S., particularly among 18 to 25 year olds.3

Why Does Cocaine Enlarge Your Pupils?

There are two ways cocaine causes dilated pupils: 

  1. Cocaine triggers the release of brain chemicals like dopamine and endorphins. Having high levels of these chemicals leads to cocaine eyes. 
  2. Cocaine triggers the release of a hormone called norepinephrine. It also blocks the hormone’s reabsorption. Norepinephrine dilates the eyes. Like adrenaline, it is released by the adrenal gland in an emergency and reabsorbed after. Because cocaine blocks the reabsorption, the amount of norepinephrine in the blood remains high in cocaine users, which explains cocaine eyes.4

Aside from making dilated eyes, cocaine can also cause bloodshot eyes. This happens because cocaine triggers the constriction of blood vessels. In turn, blood pressure increases, leading to bloodshot eyes.

Cocaine eyes are a common sign of cocaine use. 

Snorted cocaine can trigger pupil dilation in a few minutes and last for 30 minutes. Dilation is more immediate with freebase or crack cocaine, though the effect usually lasts for up to 7 minutes.4

Typically, the eyes’ pupils dilate in low light. They do this so that they can gather more light for visual clarity. On the other hand, pupils shrink in bright light to control the entry of light. 

Too much light can hurt the eyes. That’s why people squint or cover their eyes in bright conditions. 

It’s not surprising to see cocaine users wearing sunglasses (even in low light) due to pupil dilation. 

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How Cocaine Can Harm Your Eye Health 

Long-term cocaine users can develop more serious eye health conditions like the ones listed below:5

Corneal Damage

The cornea is the clear protective layer at the front of the eye. 

Long-term cocaine use increases a person’s chance of getting crack eye syndrome. It’s a collection of corneal conditions, ranging from mild punctate keratitis to total blindness.6,7 

Keratitis is corneal inflammation. Punctate keratitis is a subtype where the upper corneal layer is inflamed. 

The mechanism of how cocaine causes corneal damage is unclear, but it’s thought to be due to any of the following factors:  

  • Snorted cocaine or impurities in cocaine (like talc, sugar, flour, or starch) that cause surface damage7, 8
  • Smoked cocaine that has direct toxic effects4
  • Rubbing the eyes after touching cocaine9
  • Microorganisms like Streptococcus mitis, Capnocytophaga, and Candida albicans9 

Orbital Damage

The orbit is part of the skull that houses the eyeball, the muscles that move the eye, the tear gland, blood vessels, and nerves. 

Snorting cocaine can severely damage the nasal lining. This can cause sinusitis and further lead to various orbital complications.10 Cocaine use can also cause fungal and bacterial infections, finding their way into the orbits.11

Retinal Damage

The retina is the thin lining at the back of the eye. The retina receives light and converts it to neural signals. 

Here are the different retinal damages associated with cocaine use: 

  • Retinal vascular occlusive disease: Chronic cocaine use can cause high blood pressure, damaging retinal blood vessels.7 Furthermore, small blood clots in the retina caused by intravenous drug use can reduce blood flow in the area.
  • Talc retinopathy: Talcum powder in cocaine can be deposited after chronic cocaine injections.7, 12 The particles would appear as yellow crystals in the retina.13, 14
  • Maculopathy: There are also instances of cocaine-induced macular degeneration. The macula is a small spot at the back of the retina. A progressive loss of central vision characterizes maculopathy.

Other Eye Conditions

Some other ways cocaine can damage your eyes include:

  • Glaucoma: This is when the optic nerve is damaged. Cocaine and other drugs that dilate the pupil can lead to glaucoma.4, 15
  • Endophthalmitis: This is an infection of the tissues or fluids inside the eyeball. It can be caused by microorganisms like Candida, Aspergillus, and Bacillus from dirty needles. These germs can reach the eye through the bloodstream.4
  • Cycloplegia: This is paralysis of the ciliary muscle of the eye. This muscle changes the eye lens’ shape when focusing on near or far objects. High cocaine concentrations may cause cycloplegia.4
  • Retracted upper eyelid and bulging eyeballs: Common in chronic cocaine users.4 
  • Yellow eyes: A sign of a liver or kidney problem that can be caused by cocaine.
  • Rapid eye motion: Irregular eye movements until cocaine's effects wear off.  

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Signs of Cocaine Use

The most common sign of cocaine use is the “high” feeling or euphoria. 

People would feel high, energetic, or talkative. Some may be hypersensitive to sight, sound, and touch. Some may even feel a lesser need to eat and sleep.16

Taking larger amounts of cocaine can intensify the high feeling. But this can also lead to restlessness, irritability, paranoia, and violent behavior.

Other signs of cocaine use are cocaine eyes, hyperthermia (higher body temperature), increased heart rate, and increased blood pressure.

Some users may experience tremors, vertigo, and muscle twitches. Others may feel restlessness, irritability, anxiety, panic, and paranoia. 

Long-term cocaine users may have burned lips and fingers if they smoke cocaine, track marks if they inject it, or nosebleeds and runny noses if they snort it.1

Other Risks of Cocaine Use 

Here are some other risks of cocaine use:

Cocaine Addiction

Cocaine can trigger the release of several brain chemicals, one of which is dopamine

In typical situations, the body releases dopamine to send a reward signal to the brain. This makes people feel good while doing certain activities, like eating delicious food, having sex, or exercising.

When a person uses cocaine, dopamine builds up and sends a more intense reward signal to the brain. This is what leads to the high feeling experienced by cocaine users. 

The high feeling, however, doesn’t last long. It wears off, leading the user to crash and feel sluggish. 

Users would then feel the urge to binge-use with high doses of cocaine. This “binge and crash” cycle goes on, ultimately leading to cocaine addiction. 

Furthermore, chronic cocaine users can develop tolerance to the high feeling. 

They would use cocaine for pleasure, but they may not achieve the same feeling they had in their early stages of using cocaine. They would then increase the dose to intensify and prolong the pleasurable cocaine effects. 

Medical Complications

Long-term and frequent cocaine use can lead to more serious health problems.17 These conditions include:

  • Lung damage
  • Increased risk of asthma and severe allergic reactions
  • Gastrointestinal complications, like nausea, abdominal pain, and severe bowel gangrene (tissue death)
  • Increased risk of contracting HIV and viral hepatitis
  • Malnourishment due to cocaine’s tendency to decrease appetite
  • Heart attacks, stroke, and irregular heart rhythm
  • Headaches, seizures, strokes, and coma
  • Death due to heart attack or seizure
  • Bleeding and balloon-like bulges in the brain
  • Hallucinations and losing touch with reality
  • Impaired cognitive functions, like memory loss, inability to sustain attention, and indecisions involving rewards or punishments
  • Movement disorders (like Parkinson’s disease)

Treatment Options for Cocaine Abuse

Here are some treatment options for cocaine abuse:

Pharmacological Approaches

There are currently no medicines that can act as substitutes for cocaine and other stimulants. 

However, health professionals may offer a few options to help patients deal with cocaine-related symptoms.1,18 These options include:

  • IV benzodiazepines for agitation, hypertension, and seizures
  • Cooling techniques for hyperthermia
  • Sleep medications for sleep problems
  • Disulfiram if the person also has both drug and alcohol use problems

Behavioral Approaches

Behavioral therapies are often the only available and effective treatments for cocaine addiction recovery.1, 19, 20 They include:

  • Contingency management (CM): Also called motivational incentives, this addiction treatment process uses a system that rewards points to patients who abstain from cocaine use. Patients can exchange these points for items like a gym membership, movie tickets, or anything that encourages healthy living. 
  • Cognitive-behavioral therapy (CBT): This is effective for preventing relapse. In this setting, health professionals provide medical advice to help patients understand their substance use and develop essential skills for addiction recovery.
  • Therapeutic communities (TCs): These are drug-free residences where residents help each other change their behaviors. They usually require a 6- to 12-month stay. They also include vocational rehabilitation and other services that can help residents be successfully reintegrated into society. 

If you need help in overcoming cocaine addiction, speak with an addiction specialist today.

Resources

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  1. Cocaine.” Drugs.com
  2. “Drug Scheduling.” U.S. Drug Enforcement Administration, U.S. Department of Justice. 
  3. Hedden, Sarra, et al. “Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health.” Substance Abuse and Mental Health Services Administration; 2015. 
  4. Dhingra, Deepika, Savleen Kaur, and Jagat Ram. “Illicit drugs: Effects on eye.” The Indian journal of medical research vol. 150,3 : 228-238.
  5. Karbach, Nicholas, et al. “How Drug Abuse Affects the Eye.” Review of Optometry, September 15, 2018.
  6. Pilon, Andrew and Jill Scheiffle. “Ulcerative keratitis associated with crack-cocaine abuse.” Cont Lens Anterior Eye vol. 29,3 :263-7. 
  7. Mantelli, Flavio, et al. “Cocaine snorting may induce ocular surface damage through corneal sensitivity impairment.” Graefes Arch Clin Exp Ophthalmol vol. 253,5 :765-72.
  8. Ravin JG, and LC Ravin. “Blindness due to illicit use of topical cocaine.” Ann Ophthalmol vol. 11,6 :863-4. 
  9. De Vasconcelos, Stefânia Barbosa Diniz, et al. “Acquired anterior staphyloma after corneal ulcer associated with the use of crack.” Arq. Bras. Oftalmol. vol. 79,7 :4. 
  10. Siemerink, Martin, Nicole Freling, and Peerooz Saeed. “Chronic orbital inflammatory disease and optic neuropathy associated with long-term intranasal cocaine abuse: 2 cases and literature review.” Orbit vol. 36,5 :350-5. 
  11. Silva-Araújo, A, and MA Tavares. “Development of the eye after gestational exposure to cocaine. Vascular disruption in the retina of rats and humans.” Ann N Y Acad Sci vol. 801 :274-88. 
  12. Colatrella N, and TE Daniel. “Crack eye syndrome.” J Am Optom Assoc vol. 70,3 :193-7. 
  13. Tran, Kevin, and Pauline Ilsen. “Peripheral retinal neovascularization in talc retinopathy.” Optometry vol. 78,8 :409-14. 
  14. Zoumalan, Christopher, and Michael Marmor. “Revisiting Talc Retinopathy.” Arch Ophthalmol vol. 125,7 :988. 
  15. Firth, AY. “Class A drug abuse: an ophthalmologist's problem?” Eye vol. 19 : 609–610.
  16. “Cocaine Research Report: What are the short-term effects of cocaine use?” National Institute On Drug Abuse, May 2016.
  17. “Cocaine Research Report: What are the long-term effects of cocaine use?” National Institute On Drug Abuse, May 2016.
  18. O’Malley, Gerald, and Rika O’Malley. “Cocaine (Crack).” Merck Manual Professional Version, Merck Sharp & Dohme Corp., May 2020.
  19. “Cocaine Research Report: How is cocaine addiction treated.” National Institute On Drug Abuse, May 2016. https://www.drugabuse.gov/publications/research-reports/cocaine/what-treatments-are-effective-cocaine-abusers.
  20. “Cocaine addiction: get help.” National Health Service, April 15, 2020.

Related Pages

Crack Cocaine: Effects, Risks & Addiction Treatment

Smoking Crack

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