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Cocaine Eyes Signs & Symptoms

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

Cocaine is one of the most commonly abused illegal drugs. There are noticeable signs of cocaine abuse, especially the effects it has on the eyes.

Cocaine Eyes Signs & Symptoms

Cocaine is a white, crystal like, fine powder. Available on the street as an illegal stimulant drug, usually referred to as blow, powder, snow or coke.

Cocaine can be snorted in powder form, or can be modified in a number of ways to be injected, smoked or inhaled in a process called freebasing.

Cocaine effects tend to only last a short time, and people often end up binging on cocaine to maintain the high of the drug.

Abusing cocaine comes with many risk factors, which include unpredictable behavior, addiction, changes in the brain (permanent and temporary), cardiovascular issues, respiratory problems and other organ system complications.

As part of the central nervous system (CNS) the visual system is affected by cocaine use. The CNS system, including the brain, is directly affected by cocaine use, and the following information provides insight into how cocaine can affect the body.

What Are Cocaine Eyes?

Cocaine eyes, also known as cocaine pupils, refer to how the pupils appear after they have taken cocaine. Cocaine tends to affect the eyes in a couple different ways.

Almost all drugs cause changes in the eyes, whether they dilate or pinpoint, become bloodshot or glassy. Eyes tend to be the telltale of substance abuse, and cocaine use is no different.

Cocaine is a stimulant that causes chemical and endorphin release in the brain, and as a result the pupil of the eye dilates. This specific action is what is referred to as cocaine eyes.

Extreme dilation of the pupils results in a sensitivity to light, as more light is let in through the pupil. People on cocaine may even wear sunglasses when it doesn’t seem bright to others.

Cocaine also causes expansion of blood vessels, which can result in bloodshot eyes or the whites of the eyes may appear red.

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Cocaine Effects On The Brain

Cocaine use stimulates the brain and opens a floodgate of dopamine that surges into the brain. Instead of the brain cleaning up the dopamine and using it another day, the dopamine remains active while on cocaine.

This flood of dopamine is what causes the euphoric feeling associated with cocaine, but dopamine has long been connected to other important functions of the brain and addiction as well.

Glutamate, another excitatory neuron, is also affected by cocaine abuse. Cocaine use increases glutamate release in the reward center of the brain, including the nucleus accumbens. This area of the brain is believed to play a significant role in addiction.

The euphoric effects of cocaine do not last long, which often leads to repeated use over a short period of time. This binging pattern can lead to permanent changes to the function of the brain, neural pathways and structures of the brain.

As dopamine and glutamate continue to be released in increasingly high amounts in the reward centers of the brain, cocaine use also affects the stress response area of the brain. The ventral tegmental area overlaps both the stress and reward circuits of the brain, and cocaine impacts this area significantly.

The ventral tegmental area communicates stress cues as well as drug cues, which include cocaine seeking behaviors. Research has shown that animals previously exposed to cocaine are more likely to seek out cocaine in highly stressful situations.

Other research has shown that long-term, chronic cocaine use decreases function in the orbitofrontal cortex (OFC). This area is responsible for decision making, reasoning and introspection.

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Damage to the OFC typically results in poor decision making. In relation to cocaine use, this negative impact can make it difficult to accept the negative consequences of cocaine use, which may result in lashing out, anger, frustration, aggression or even violent outbursts.

The observable effects of cocaine use on the brain can result in auditory hallucinations, paranoia, psychosis and restlessness. Cocaine also increases cortisol and other stress hormones.

The longer a person abuses cocaine, the stronger the altered neuronal pathways become. Over time, these changes can become permanent, and stopping becomes quite difficult. It is common for a person to experience deep depression after long term cocaine use.

Cocaine Effects On The Eyes

There are a number of risks to the eyes as a result of cocaine use, both short- and long-term. Some of the more common include:

Keratitis causes cornea inflammation. This can distort vision in the early stages. Long term cocaine abuse causes persistent inflammation, which often leads to ulcers, infections and eventual corneal perforation.

Endophthalmitis is a result of using dirty needles. This infection resides inside the eye. Left untreated, the infection can spread all over the body, having numerous side effects.

Glaucoma can occur if there are changes in blood pressure in the body. These changes alter the pressure in the fluid within the eye, and long-term increases in fluid pressure within the eye often results in glaucoma.

Maculopathy refers to the degeneration of the retina. This results in blurred vision and distortions in the center of the visual field.

Ocular bone damage snorting drugs can result in perforations (holes or severe damage) to the septum and other nasal passages. Continued use can further damage connected tissues and small bone structures, including the ocular bones.

Nystagmus is commonly known as rapid eye motion. Continued cocaine use can result in permanent changes to eye movement, which may be an indication of brain damage

Retinal Vascular Occlusive Disease (ROVD) is the most common disease linked to vision loss. It can be triggered by long term cocaine use, which causes changes in blood pressure. ROVD is a result of abnormalities in the retina that can lead to partial or total blindness.

Talc Retinopathy is a crystal-like buildup (usually yellow or white) on the vascular tissue of the eye. This specific problem has been linked to IV drug use and snorting of drugs.

Yellow Colored Eyes is usually indicative of a liver or kidney problem. Long term stimulant use, like cocaine, can result in jaundice by way of liver damage or failure.

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Summarize Cocaine Eyes

Cocaine side effects vary from person to person, how much is used, and how often cocaine is abused. Cocaine effects the eyes in a number of ways, from redness to blindness. Cocaine eyes are a result of the pupil dilating significantly as a result of the stimulation of the excitatory area of the brain.

BMJ Case Reports - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3029671/

Canadian Journal of Ophthalmology - https://www.canadianjournalofophthalmology.ca/article/S0008-4182(15)00415-9/abstract

Endocrinology, Diabetes & Metabolism - https://edm.bioscientifica.com/view/journals/edm/2017/1/EDM16-0131.xml

Graefe’s Ophthalmology - https://www.ncbi.nlm.nih.gov/pubmed/25644620

National Institute on Drug Abuse - https://www.drugabuse.gov/publications/cocaine/what-are-some-ways-cocaine-changes-brain

Review of Optometry - https://go.galegroup.com/ps/anonymous?id=GALE%7CA557838288&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=1930160X&p=AONE&sw=w

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC
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