Opioid Use May Be the Cause Of A Rare Eye Infection

By Paul Gaita 04/25/17

Researchers are investigating a rare eye fungus which can be introduced to the body through IV drug use. 

Woman covers her inflamed eye with one of her hands.

Researchers in New England have found possible links between intravenous opioid use and a rare fungal infection that can cause serious vision problems and even blindness.

Their findings, published in the April 20 issue of the Journal of the American Medical Association Ophthalmology, drew connections between increased use of IV drugs like heroin in the region and a rise in the number of patients diagnosed with endogenous fungal endophthalmitis—an infection caused by a fungus that grows inside the eyeball and can be introduced to the body through IV drugs.

The report cites 10 cases in which patients were treated for the infection at the New England Eye Center at Tufts Medical Center in Boston between May 2014 and May 2016—more than twice the number of such cases reported between 2012 and 2014. Of the 10 patients, six reported injecting heroin, while another had injected buprenorphine; the other three patients admitted that they too had used IV drugs, but did not specify.

Endogenous fungal endophthalmitis is often difficult to detect because the infection presents itself as an eye problem, such as reduced vision or redness, with little else connecting the symptoms to the infection; in nearly all of the cases, the patients reported eye problems and no other symptoms, though one patient had a high temperature.

The admission of IV drug use on the part of the patient was often the primary means of determining that they had the infection; once doctors at the center linked the eye symptoms and the drug use, they administered anti-fungal medication to nine of the patients, while the tenth patient refused admittance into the hospital.

Five of the nine required surgery to remove the vitreous humour (fluid in the eyeball) from their eyes; once the gel-like substance, which helps protect the retain, was removed, the five patients reported moderately improved vision. The three patients who did not receive the surgery reported 20/300 vision, which is considered legally blind. Two of the patients did not report to the clinic after the diagnosis, so their condition is unknown.

While the researchers acknowledge that the rise in cases found at their clinic is due pretty much entirely to IV opioid drug use, the report suggests that given the severity of the infection if left untreated, doctors should take more detailed history from, and engage in, more open talks with patients reporting both eye problems and IV drug use.

They noted that three of the nine patients initially denied having used IV drugs, but upon admitting to the use at a later point, were provided with "appropriate treatment decisions," according to the report.

New England's mortality rates from drug overdose in nearly every county in the six-state region doubled between 2002 and 2014, and have continued to rise in subsequent years.

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, Amazon.com and The Los Angeles Beat, among many other publications and websites.