A 35 y.o. male presents with decreased vision in the R eye and pain.

What caused this problem?

meth eyef.jpg

Our patient had corneal destruction from chronic methamphetamine use.  This resulted in descemetoceles ( outpouching of the inner layer of the  cornea).   Drug induced ocular symptoms also include  retinal vasculitis, episcleritis, panophthalmitis, endophthalmitis, scleritis, and globe rupture.

descem.JPG

In the initial stages of chemical eye burns irrigation and correction of the pH to between 7.0 and 7.2  should be accomplished. Fluorescein staining may be absent with a complete epithelial defect.  In mild burns a topical steroid is applied four times a day for one week to control inflammation. A cycloplegic is also given three times per day.  In more severe burns prednisolone is given q 1 hr while awake and tapered rapidly between days 10 and 14 to minimize the risk of corneal melting. Amniotic membrane is often used to cover the cornea in severe burns.   In some cases limbal stem cell transplants are performed from the contralateral eye.

 a more subtle descemetocele

a more subtle descemetocele

 the eye exam after a corneal transplant.

the eye exam after a corneal transplant.

Our patient will be receiving a corneal transplant.

 

Hazin R,Cadet JL, Kahook MY, Saed. Ocular manifestations of crystal methamphetamine use. 2009 Neurotox Res. 15(2):187-91.

Hemmati H, Colby K, edited by Scott I and Fekrat S. Treating acute chemical injuries of the cornea. 2017 Eyenet Magazine.