Acquired anterior staphyloma after corneal ulcer associated with the use of crack

Abstract

CASE REPORTA 30-year-old black man presented with a 4-week history of a foreign body sensation, redness, and pain in his right eye. His left eye was stable. The patient had a history of crack cocaine and injected heroin abuse. He was homeless and admitted to using crack cocaine daily over the past 4 months. He denied any previous contact lens use, trauma, or ocular surgery. He was otherwise quite well with no systemic symptoms, and his general medical history was unremarkable.On examination at our hospital, uncorrected visual acuity was found to be light perception (LP) in the right eye and 20/25 in the ABSTRACTWe describe an unusual case of acquired anterior staphyloma in a patient addicted to crack cocaine. At the beginning of his crack cocaine abuse, he noticed redness and irritation of his eyes. Over the next 4 months, the patient also noticed the onset of decreasing visual acuity in his right eye (OD). Initially, his visual acuity was light perception in OD, and slit-lamp examination revealed a corneal infiltrate with a peripheral perforation and an iris prolapse. The patient was hospitalized to ensure compliance with the prescribed treatment and was advised to undergo therapeutic keratoplasty; however, the patient left the hospital against medical advice and was lost to follow-up for the next 6 months. He returned with complaints of photophobia and the inability to close his right eyelids. At this time, his cornea had developed an anterior staphyloma and required a sclerokeratoplasty. Following surgery, the patient was again lost to follow-up.

Smoke Gets in the Eye: A systematic review of case reports of ocular complications of crack cocaine use

“…Excessive or inappropriate use of anaesthetic drops has been implicated in the development of corneal ulcers with colonisation by diverse microbes [23][24][25][26]. Application of anaesthesia to the eye can diminish the blink reflex and thereby increase the risk for corneal dehydration [27].…”

Sclerokeratoplasty for the early management of acquired anterior staphyloma

“…The acquired anterior staphyloma occurs when there is corneal perforation and subsequent adhesion of the uveal tissue to the lesion [1][2][3]7]. Due to the vascularization of the iris, a pseudocornea is formed, being unable to withstand intraocular pressure and, consequently, results in progressive protrusion [1,4,6].…”

“…Graft surgery involves greater complexity, largely due to loss of limbic support and consequent intraoperative iris diaphragm protrusion [3,6,7]. The patient described was submitted to sclerokeratoplasty in order to avoid evisceration and with the objective of future refractive keratoplasty.…”

“…The few treatment options, alternatives to mutilation, include penetrating keratoplasty, sclerokeratoplasty, mushroom graft and dural patch [3,[5][6][7]. Due to the technical difficulty of treatment, the therapeutic options should be evaluated in a systematic and criterious way, in order to reduce intra and postoperative complications.…”

Drugs of abuse and ocular effects

“…[39][40][41][42][43][44][45][46][47] There are also recurrent reports of neurotrophic keratopathy and a case of corneal perforation leading to anterior staphyloma. 48 Occasional reports link cocaine to the following cranial nerve conditions: opsoclonus, pupil sparing third-nerve palsies, bilateral internuclear ophthalmoplegia following a brain haemorrhage, neuromyelitis optica, or triggered myasthenia gravis (possibly from blocking sodium channels and thus slowing down presynaptic neuronal transmission). [49][50][51][52][53] While cocaine is commonly reported to induce mydriasis, it is occasionally reported to cause anisocoria (if only one eye is topically exposed).…”