Why Pupils Enlarge From Cocaine Use and How Long It Lasts
In This Article
What are Cocaine Eyes?
Cocaine eyes or cocaine pupils are a common sign of cocaine use. It is a physical side effect of cocaine that causes your eyes to look large (dilated). This happens because cocaine is a stimulant that releases large amounts of dopamine and endorphins.
When large amounts of endorphins are released, your eyes react by enlarging the pupils. Endorphins also relieve pain and improve your mood.
Cocaine is an illegal drug in the U.S. and is considered a Schedule II drug. This means the drug can be used for medical purposes but has a high potential for abuse.2
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Why Does Cocaine Enlarge Your Pupils?
As mentioned before, cocaine triggers the release of dopamine and endorphins to cause eye dilation. However, this can also happen due to cocaine triggering the release of another hormone called norepinephrine.
Norepinephrine is released by the adrenal gland in an emergency and reabsorbed afterward. This causes your eyes to dilate.
Cocaine blocks hormone reabsorption. This response causes the amount of norepinephrine in your blood to stay high, leading to cocaine eyes.4
How Long Do Cocaine Eyes Last?
Snorted cocaine can trigger pupil dilation in a few minutes and lasts 30 minutes. Dilation is more immediate with freebase or crack cocaine, though the effect usually lasts 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 light entry.
Too much light can hurt the eyes. That’s why it’s unsurprising to see cocaine users wearing sunglasses due to pupil dilation.
How Cocaine Can Harm Your Eye Health
Aside from dilating your eyes, cocaine can also cause bloodshot eyes. This happens because cocaine triggers the constriction of blood vessels.
The increase in blood pressure leads to bloodshot eyes. Long-term cocaine users can develop more serious eye health conditions like the ones listed below:5
Corneal Damage
The cornea is the transparent protective layer at the front of the eye. Long-term cocaine use increases a person’s chance of getting crack eye syndrome.
This collection of corneal conditions ranges from mild punctate keratitis to total blindness.6,7 Punctate keratitis is a subtype of corneal inflammation where the upper corneal layer is inflamed.
It’s unclear how cocaine causes corneal damage, but it’s thought to be due to any of the following factors:4,7,8,9
- Contamination through eye rubbing
- Contamination through snorting
- Direct toxic effects of smoking cocaine
- Impurities in cocaine like talc, sugar, flour, or starch
- Microorganisms that spread throughout the body due to contaminated needles
Orbital Damage
The orbit is part of the skull that houses and protects the eyeball, including:
- The muscles that move the eye
- The tear gland
- Blood vessels
- Nerves
Snorting cocaine can severely damage the nasal lining, possibly causing sinusitis and leading to various orbital complications.10 Cocaine use can also cause fungal and bacterial infections to get into the eye 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 vessels7
- Talc retinopathy: Talcum powder in cocaine can be deposited after chronic cocaine injections.7, 12
- Maculopathy: Cocaine-induced macular degeneration that causes a progressive loss of central vision
Other Eye Conditions
Some other ways cocaine can damage your eyes include:
- Glaucoma: Cocaine and other drugs that dilate the pupil can lead to glaucoma4,15
- Endophthalmitis: An infection of the tissues or fluids inside the eyeball4
- Cycloplegia: Paralysis of the ciliary muscle of the eye due to high cocaine concentrations4
- Retracted upper eyelid and bulging eyeballs: Common in chronic cocaine users4
- Yellow eyes: A sign of a liver or kidney problem caused by cocaine
- Rapid eye motion: Irregular eye movements until cocaine's effects wear off
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Other Signs of Cocaine Use
Aside from cocaine eyes, the most common symptom of cocaine use is the “high” feeling or euphoria you experience after using the drug.
Other signs of cocaine use include:
- Bursts of energy or restlessness
- Hypersensitivity to sight, sound, and touch
- Loss of appetite
- Irritability and aggressiveness
- Paranoia
- Hyperthermia
- Increased heart rate and blood pressure
- Tremors
- Vertigo
- Anxiety or panic
Long-term cocaine users may have burned lips and fingers if they smoke cocaine. If they’re injecting, you may see track marks on their body. If they’re snorting cocaine, they may have nosebleeds and runny noses.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, including dopamine. Dopamine is a neurotransmitter that sends reward signals to the brain leading to a euphoric feeling or a “high.”
This euphoric feeling is what causes cocaine users to use the drug. However, the high doesn’t last long.
Users may then start to binge cocaine use to maintain their high. This “binge and crash” cycle continues, eventually leading to cocaine addiction.
Medical Complications
Long-term and frequent cocaine use can lead to more severe health problems.17 These conditions include:
- Lung damage
- Increased risk of asthma and severe allergic reactions
- Gastrointestinal complications, like nausea, abdominal pain, and painful 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)
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Treatment Options for Cocaine Abuse
Here are some treatment options for cocaine abuse:
Pharmacological Approaches
Currently, no medicines 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
Treatment Programs
Behavioral therapies are often the only available and effective treatments for cocaine addiction recovery.1, 19, 20 They include:
- Contingency management (CM): Uses rewards and incentives for positive reinforcement to promote sobriety and healthy living
- Cognitive-behavioral therapy (CBT): A short-term therapy technique that explores the link between thought patterns and addiction
- Inpatient treatment: Involves checking yourself into a rehab facility for 24-hour medical supervision
- Outpatient treatment: A treatment program where patients are freely allowed to leave the rehab facility
If you need help overcoming cocaine addiction, speak with an addiction specialist today.
Summary
Cocaine eyes are a common sign of cocaine use. It causes the eyes to appear larger (dilated). A release of dopamines, endorphins, and norepinephrine in the brain causes your eyes to dilate.
Cocaine eyes also can lead to bloodshot eyes and potentially cause severe eye damage. It is a harmful substance with a high potential for addiction and abuse. Fortunately, there are available treatment options to help you recover.
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- Cocaine.” Drugs.com.
- “Drug Scheduling.” U.S. Drug Enforcement Administration, U.S. Department of Justice.
- Hedden 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.
- Dhingra et al. “Illicit drugs: Effects on eye.” The Indian journal of medical research, 2019.
- Karbach et al. “How Drug Abuse Affects the Eye.” Review of Optometry, 2018.
- Pilon, A., Scheiffle, J. “Ulcerative keratitis associated with crack-cocaine abuse.” Cont Lens Anterior Eye, 2006.
- Mantelli et al. “Cocaine snorting may induce ocular surface damage through corneal sensitivity impairment.” Graefes Arch Clin Exp Ophthalmol, 2015.
- Sein et al. “Visual impairment caused by recreational usage of cocaine--a case report.” Przegl Lek, 2010.
- De Vasconcelos et al. “Acquired anterior staphyloma after corneal ulcer associated with the use of crack.” Arq. Bras. Oftalmol, 2016.
- Siemerink et al. “Chronic orbital inflammatory disease and optic neuropathy associated with long-term intranasal cocaine abuse: 2 cases and literature review.” Orbit, 2017.
- Silva-Araújo, A., Tavares, MA. “Development of the eye after gestational exposure to cocaine. Vascular disruption in the retina of rats and humans.” Ann N Y Acad Sci, 1996.
- Colatrella N., Daniel, T. “Crack eye syndrome.” J Am Optom Assoc, 1999.
- Tran, K., Ilsen, P. “Peripheral retinal neovascularization in talc retinopathy.” Optometry, 2007.
- Zoumalan, C., Marmor, M. “Revisiting Talc Retinopathy.” Arch Ophthalmol, 2007.
- Peragallo et al. “Ocular manifestations of drug and alcohol abuse.” Curr Opin Ophthalmol, 2013.
- “Cocaine Research Report: What are the short-term effects of cocaine use?” National Institute On Drug Abuse, 2016.
- “Cocaine Research Report: What are the long-term effects of cocaine use?” National Institute On Drug Abuse, 2016.
- O’Malley, G., and O’Malley, R. “Cocaine (Crack).” Merck Manual Professional Version, Merck Sharp & Dohme Corp., 2020.
- “Cocaine Research Report: How is cocaine addiction treated.” National Institute On Drug Abuse, 2016.
- “Cocaine addiction: get help.” National Health Service, 2020.
