![]() ![]() ![]() In an analysis of 1,633 emergency department visits for acute “bath salt” intoxication, 7.1% of patients had mydriasis, although co-ingestion of other intoxicants occurred at a rate of 26%. Sale of 31 specific “bath salt” compounds in the United States was banned in July 2012. Route of administration of bath salts includes inhalation, oral ingestion, and injection. ![]() Increasing use of a newer designer drug, “bath salts,” comprised of a variety of molecules in a class of chemicals called phenethylamines (which includes methamphetamine, 3,4-methylenedioxy- N-methylamphetamine (MDMA), and methcathinone) has led to a substantial number of poison control calls in the United States. Methamphetamine also causes pupillary mydriasis. Cocaine’s inhibition of reuptake of norepinephrine causes pupillary mydriasis (useful in clinical practice in determining the presence of a Horner syndrome). Use of opiates, both legally and illicitly, leads to pupillary miosis. Multiple drugs of abuse affect pupil size and reaction. Finally, an orally ingested anti-tussive agent, benzonatate, has been reported to be abused as a topical anesthetic by breaking the capsules and directly applying the contained gel. A psychiatric evaluation may be indicated for patients with topical anesthetic abuse if they exhibit signs of Munchausen’s syndrome. These patients were followed for at least one year, with 15.4% of the patients becoming legally blind. Despite warnings of the devastating ocular consequences of anesthetic abuse, 12 of these patients continued to abuse their topical anesthetic. These patients either self medicated with proparacaine hydrochloride (available over the counter in Turkey) prior to hospitalization for corneal disease, or self medicated while hospitalized. A series of 19 patients from Turkey described individuals who had suffered occupational injuries such as metallic foreign bodies, welding flash, or chemical injury. ![]() Self-prescription of topical anesthetics is well known to induce severe corneal damage. described a case series of presumed methamphetamine-related corneal ulceration with devastating keratitis that resulted in perforation requiring penetrating keratoplasties. Agents often implicated in these injuries include cocaine, crack cocaine, and topical anesthetics. Both prescribed and illicit drugs of abuse topically-applied may anesthetize the cornea, leading to injuries of the ocular surface and predisposition to infectious corneal ulcers. The cornea contains the highest concentration of nerve endings in the entire body. A comparative case-control study between men who drank heavily (≥4 drinks per day) and non-drinkers showed that heavy ethanol ingestion was associated with a decreased tear break up time, lower Schirmer I test, as well as altered conjunctival impression cytology in comparison to non-drinkers. In this manner, ethanol could exacerbate the signs and symptoms of dry eye syndrome. The proposed mechanisms for the altered tear function were that ethanol increased tear osmolarity, acted as a solvent, and could disturb cytokine production. The Beaver Dam Eye Study found that dry eye symptoms were related to a history of heavy alcohol consumption, but not current alcohol consumption.Ī recent investigation of patients following ethanol ingestion described detection of ethanol in the tears, along with a decreased tear breakup time. Smoking has been associated with an increased incidence of dry eye. Abnormalities of the tear film can induce severe visual dysfunction due to the creation of an irregular refracting surface. ![]()
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