Optic Neuropathy Caused by Naso-Orbital Mass in Chronic Intranasal Cocaine Abuse

Abstract

A 48-year-old woman with a history of chronic intranasal cocaine abuse presented with unilateral proptosis associated with severe visual loss from optic neuropathy in the right eye. Imaging showed extensive bone and soft tissue destruction in the paranasal region and an orbital mass. Initial biopsies suggested a low-grade neoplasm. The correct diagnosis was established only on repeat biopsy, which revealed marked pleomorphism and nonspecific chronic inflammation with irregular collagen bundles containing thick-walled blood vessels. This case emphasizes that intranasal cocaine abuse may clinically, radiographically, and histopathologically mimic a neoplasm or a necrotizing vasculitis.

Ocular manifestations of drug and alcohol abuse

“…[50] Intranasal cocaine abuse has led to severe sinusitis extending into the orbit causing an optic neuropathy and orbital apex syndrome. [51,52] In one case of orbital cellulitis, superior ophthalmic vein thrombosis resulted from direct intraorbital injection of heroin. [53]…”

Cocaine induced midline destructive lesions

“…Centrifugal internal extension of the lesions and erosion of middle and superior turbinates occur in more severe cases (7) , and are often reported (7,15,16,21,23,25,29,31,32,34,41,45,63) . Further expansion of CIMDL can involve the lateral wall (23,29,34,41,45,57,61,64,66,71,72,73) or the floor of the nasal cavity causing hard and soft palate perforations ( Figure 1a, 1b, 3b and 3c), documented in 35 reports, that can give rise to dysphagia, rhinolalia and oro-nasal reflux (7,14,15,21,25,26,(28)(29)(30)33,(36)(37)(38)(39)40,41,45,47,48,(51)(52)(53)…”

Recurrent Optic Perineuritis after Intranasal Cocaine Abuse

“…A tumour was suspected, but several tissue biopsies only revealed nonspecific chronic inflammation. 6 The other case was a 29-year-old male with extensive bony destruction due to nasal cocaine consumption. He developed a subperiosteal abscess and optic neuritis that responded well to treatment with IVMP and antibiotics.…”

“…5 Two more cases were reported. 6,7 The first was a 48-year-old woman with chronic intranasal cocaine consumption in whom an infiltrating mass from the maxillary sinus extended into the orbit, leading to proptosis and optic neuropathy. A tumour was suspected, but several tissue biopsies only revealed nonspecific chronic inflammation.…”

“…Our review of the literature revealed five cases with optic neuritis following cocaine consumption. [4][5][6][7] Newman et al were first to describe a case of bilateral optic neuropathy and osteolytic sinusitis in 1988 in a patient with intranasal cocaine abuse. 4 One year later, Goldberg et al presented three cases of orbitopathy or optic neuropathy associated with long-standing intranasal cocaine abuse and chronic sinusitis.…”