Chronic orbital inflammatory disease and optic neuropathy associated with long-term intranasal cocaine abuse: 2 cases and literature review

Orbit. 2017 Oct;36(5):350-355. doi: 10.1080/01676830.2017.1337178. Epub 2017 Aug 16.


Orbital inflammatory disease and secondary optic neuropathy is a rare but devastating complication of long-term intranasal cocaine abuse. We describe 2 patients with a history of intranasal cocaine consumption who presented with subacute onset of unilateral vision loss from optic neuropathy and limitation of abduction in the affected eye. Magnetic resonance imaging findings included an orbital mass in combination with absent nasal septum and partial destruction of the paranasal sinuses. Biopsies and histopathologic examination of the nasal cavity and the orbital mass revealed chronic inflammation. Both patients were treated with oral corticosteroids, ocular movements completely normalized but no improvement of visual acuity was noted. Intranasal cocaine abuse can cause orbital complications from chronic sinonasal inflammatory disease and these patients are at risk to develop optic neuropathy. Optic neuropathy may be caused by compression, infiltration, or ischaemia.

Keywords: Orbital inflammatory disease; cocaine snorting; optic neuropathy; orbital imaging.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Administration, Intranasal
  • Aged
  • Blindness / etiology
  • Chronic Disease
  • Cocaine / administration & dosage
  • Cocaine / adverse effects*
  • Cocaine-Related Disorders / complications*
  • Glucocorticoids / therapeutic use
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Nasal Septum / diagnostic imaging
  • Nasal Septum / drug effects
  • Optic Nerve Diseases / diagnostic imaging
  • Optic Nerve Diseases / drug therapy
  • Optic Nerve Diseases / etiology*
  • Orbital Pseudotumor / diagnostic imaging
  • Orbital Pseudotumor / drug therapy
  • Orbital Pseudotumor / etiology*
  • Paranasal Sinus Diseases / diagnostic imaging
  • Paranasal Sinus Diseases / etiology
  • Visual Acuity


  • Glucocorticoids
  • Cocaine