Nasolacrimal Duct Obstruction and Orbital Cellulitis Associated With Chronic Intranasal Cocaine Abuse

Abstract

To report the association of acquired nasolacrimal duct obstruction and orbital cellulitis in patients with a history of chronic intranasal cocaine abuse. Methods: Retrospective, consecutive case series. Results of imaging, histopathologic examinations, and clinical courses of these patients were studied. Results: Five women and 2 men (mean age, 41 years) with a history of chronic intranasal cocaine abuse (mean, 11 years; range, 5-20 years) presented with epiphora and in some cases acute onset of periorbital pain, edema, and erythema associated with fever. The suspicion of intranasal cocaine abuse was made on anterior rhinoscopy with the detection of an absent nasal septum and inferior turbinate. Computed tomographic and magnetic resonance imaging findings in 4 patients included extensive bony destruction of the normal orbital wall architec

Sinuorbital complications after intranasal cocaine abuse

“…2,11,12 therapy Systemic antibiotics, as prescribed in our case, have also been pointed out in the literature as a therapeutic option. 4,5 Responsiveness of the inflammatory orbital process to steroids was also reported by Goldberg. 5 Conclusion Orbital involvement in osteolytic destruction from cocaine abuse should be considered as a differential diagnosis in cases of orbital inflammation.…”

“…3,4,[7][8][9][10] Interestingly, in these cases, the inferomedial orbit was involved, just as in the case presented here. Optic nerve involvement, in two cases bilateral, has also been reported.…”

An overview of non-cardiac cocaine toxicity

“…These include: Wegener's granulomatosis, nasal lymphoma, localized infections, polymorphic reticulosis, and necrotizing granulomatous vasculitis (20,23,30,(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65).…”

Recurrent Optic Perineuritis after Intranasal Cocaine Abuse

“…These patients partly responded to treatment with steroids and/or antibiotics and did not suffer from an optic neuropathy at the time. 9 There is also evidence that intra-orbital inflammation following cocaineinduced chronic osteolytic sinusitis may spare the optic nerve and may either cause mechanical restriction of eye movements or possibly affect the third, fourth, and sixth cranial nerves leading to diplopia. 10 Clinical evidence for proptosis in these patients should trigger orbital imaging.…”