Keratolysis Associated with Methamphetamine Use – Incidental Diagnosis of Corneal Melt in a Patient with Acute Methamphetamine Intoxication

Abstract

Case Presentation: A 38-year-old male presented to the emergency department with methamphetamine-induced agitation. Physical exam showed clouding of the left cornea, with gelatinous appearance and associated conjunctivitis, consistent with corneal melt, or keratolysis. Discussion: Keratolysis is dissolution of the corneal stroma that can lead to corneal ulceration and vision loss. Smoking stimulants has been shown to be associated with this pattern of ocular injury, although this is a relatively rare presentation. Acute keratolysis is a unique complication of methamphetamine preparation and ingestion via smoking that can lead to corneal ulceration and loss of vision.

Ophthalmic complications associated with methamphetamine use disorder

“…Additional instances of concomitant ulcer infections and keratolysis have been reported in literature. 2 , 6 These cases emphasize the acuity and severity of methamphetamine-associated keratitis and secondary ocular complications.…”

Vision health perspectives on Breaking Bad: Ophthalmic sequelae of methamphetamine use disorder

“…A case report describes repeated corneal ulcers in a patient recurring concomitantly with periods of heavy methamphetamine smoking ( Chuck et al, 1996 ). Aerosolized and inhaled stimulant use is also associated with keratolysis, a progressive dissolution of the corneal stroma, although the mechanism by which this occurs is unknown ( Heer et al, 2020 ). Interestingly, methamphetamine concentrates in saliva at a tenfold greater concentration than in plasma ( Cook et al, 1992 ).…”

“…In addition to consumption-related smoking or thermal injury, production-related causes of ocular involvement include direct injury, exposure to caustic chemicals during production, or exposure to toxic impurities used to dilute the methamphetamine ( Heer et al, 2020 ). This is especially relevant amidst the rise of illicit methamphetamine production, which uses low-cost ingredients, some of which are dangerous and caustic ( Movahedan et al, 2015 ).…”