Orbital Changes of Cocaine-Induced Vasculitis
Author: Dharshana Ramanathan
Base Hospital / Institution: East Sussex Healthcare NHS Trust
ePoster presentation
Abstract ID: 24-469
Purpose
Chronic intranasal cocaine use can lead to an inflammatory systemic vasculitis as well as ischaemic necrosis of the septal cartilage and orbital walls. We report orbital changes in two patients with chronic cocaine insufflation.
Methods
Two male patients (35 and 46 years old) underwent full ophthalmic examination. Imaging using computerised-tomography (CT) of the head and orbits was performed as well as biopsy.
Results
Patient 1: History of recurrent left eye preseptal cellulitis. The patient had a visual acuity (VA) of 0.20 (LogMAR), left ptosis, relative afferent pupillary defect (RAPD), limited elevation, abduction and adduction and bilateral cupped discs with colour vision 10/15 (Ishihara plates). CT head showed extensive destruction of the midline nasal and paranasal structures, skull base erosions and soft tissue in the inferomedial extraconal space of both orbits.
Patient 2: Presented with pre-existing midline defects, reduced VA to 1.00 (LogMAR), normal colour vision with no RAPD and diplopia with limited elevation and abduction in the left eye. CT head also confirmed destruction of midline nasal and paranasal structures as well as the floor and medial walls of the orbits.
Biopsy confirmed necrotic tissue in both patients. The patients initially denied cocaine use but on direct questioning, revealed use in the past and repeat urine samples tested positive. Extensive investigations excluded neoplastic conditions as well as inflammatory causes such as granulomatosis with polyangiitis. Oral steroid treatment was initiated to control inflammation under combined care. Patient 2 subsequently had left medial rectus disinsertion and a corneal graft which unfortunately failed, leading to evisceration. A back-to-back sandwich flap was performed to close a medial canthal fistula followed by a glabellar flap.
Conclusion
Social history is essential to determine the underlying cause of orbital changes. Without cocaine cessation, patients had active inflammation despite continued anti-inflammatory treatment. A multidisciplinary approach is essential in the management of cocaine-induced vasculitis.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Anastasia | Pilat | East Sussex Healthcare NHS Trust |
