Bilateral central retinal artery occlusion secondary to inhalation of crack cocaine

• Published in: Clinical toxicology (Philadelphia, Pa.) Pa.), 2005-10, Vol.43 (6), p.661-661
• Main Authors: Catenacci, M H, Tuckler, V E
• Format: Article
• Language: English
• ISSN: 1556-3650

Cocaine abuse has been associated with several vascular complications in younger patients including acute myocardial infarction, stroke, and aortic dissection. Central Retinal Artery Occlusion (CRAO) secondary to intravenous or intranasal cocaine abuse has been reported very infrequently in the medical literature. There has been only one case reported as secondary to inhalation of crack cocaine. To the best of our knowledge, there are no case reports of bilateral CRAO secondary to cocaine abuse. A 50 year-old female with no past medical history presented with decreased vision in her right eye. The patient stated she awoke with blurred vision in the right eye two days prior to presentation, and lost vision completely in the right eye the day of presentation. The patient also admitted to a lesser degree of blurred vision in the left eye and to smoking crack cocaine the night before onset of symptoms. She denied eye pain, headache, temporal scalp tenderness, jaw claudication, weakness, or other neurologic complaints. Vital signs were BP of 211/119, HR of 85, and T = 98.5F. Physical exam revealed no visual acuity in the right eye with 20/100 vision in the left. An afferent pupillary defect was present on the right, the left pupil was fully reactive, and the consensual light reflex was preserved on the right. Extraocular movements were intact. On fundoscopy, both retinae appeared edematous with whitening, there was 'boxcarring' of retinal arteries on the right, and cherry-red spots were present on both macula. Neurologic exam was normal. Laboratory studies were unremarkable. The patient was admitted, blood pressure was controlled, and subsequent CT scanning of the head and carotid doppler ultrasound were normal. The patient's visual acuity improved in the left eye, and minimally in the right. Cocaine has known atherogenic and platelet-aggregating qualities, but due to the bilateral presentation of disease in this case, we speculate the pathogenesis may be more related to a sudden intense vasospasm than in-situ thrombosis. Although rare, inhalation of crack cocaine should be included in the differential diagnosis of CRAO in younger patients.