What are cocaine or “coke eyes”?

Can cocaine affect the eyes?

Both prescription and recreational drugs can affect your eyes, from minor irritation to more serious issues. Using cocaine can impact the eyes in several different ways, including enlarged pupils, eye redness and light sensitivity. 

Here’s how to recognize the effect of cocaine on the pupils and eyes — and what to do if you are concerned about a loved one.

What does cocaine do to your pupils?

Unlike certain drugs that constrict the pupils, one of the most recognizable symptoms of cocaine use is dilated pupils — sometimes called “cocaine pupils.” 

Since cocaine is a stimulant, it causes the brain to release adrenaline and endorphins. The body responds to this by dilating (enlarging) your pupils.

When it is inhaled, cocaine can affect the body within a few seconds, and the impact can last approximately five to seven minutes. When snorted, cocaine can cause an effect on the body within three minutes and last up to 30 minutes. 

Other symptoms of cocaine eyes

Aside from dilated “coke eyes,” there are several indicators that a person may be using the drug. Here are some other eye signs and symptoms of someone on cocaine:

• Light sensitivity – The eyes are more sensitive to light when the pupils are dilated.

• Eye irritation and redness – Powder or smoke (depending on the form of the drug) may irritate the eyes and cause redness, pain, itching or burning. If the eyes are touched during or after drug use, it can increase the chances of this occurring.

• Blurry near vision  – Cycloplegia, or paralysis of the ciliary muscle (eye focusing muscle), can occur when a large amount of cocaine is used at one time. An individual may complain about blurred vision and squint when trying to focus at near.

Additional general signs and symptoms of cocaine use include:

• Feeling more mentally alert

• High energy

• Irritability

• Extreme sensitivity to touch and sound

• Paranoia

• Violent or aggressive behavior (in some cases)

• Elevated blood pressure or body temperature

• Twitching, tremoring or restlessness

• Increased heart rate

• Nausea

Some people may wear sunglasses to disguise the common signs of cocaine use. It should be noted, however, that just because someone is exhibiting the above signs and symptoms, it doesn’t necessarily indicate cocaine use.

Risks and complications

Using cocaine places a person’s overall health at risk, including the eyes. It can make someone more likely to develop certain eye conditions, such as:

• Keratitis – An inflamed cornea due to irritation from smoke or powder. 

• Corneal ulcer – Cocaine may come in contact with the eyes during use, and the powder could scratch or damage the cornea.

• Maculopathy – Damage to the macula, the part of the retina responsible for fine, detailed vision.

• Retinal vein occlusion – A blockage of a vein in the retina.

• Retinal detachment – The pulling away of the retina from its normal location.

• Severe sinusitis that affects the orbit – Severe sinusitis is a major risk for those who snort cocaine. It can also lead to serious eye complications since the nasal cavity is connected to the orbit.

• Myasthenia gravis – An autoimmune disorder that causes muscle weakness and can affect the eye muscles.

• Hallucinations – A perception of an event, such as a vision, that isn’t real.

• Exophthalmos – Eye bulging that can occur with chronic use of cocaine. This condition can also place pressure on the nerve that connects the eye and brain, leading to vision loss.

• Upper eyelid reduction – Long-term cocaine use can cause the upper eyelids to retract and cause the eyes to stay wide open. Excessive dryness often occurs as a result.

• Angle-closure glaucoma – In some people, a dilated pupil can further narrow an already small angle where the fluid in the front of the eye drains, leading to angle-closure glaucoma.

Additional long-term effects of cocaine use include:

• Increased risk of diseases such as HIV and hepatitis C from using needles

• Respiratory infections and conditions such as asthma (aggravated by smoking)

• Nosebleeds, chronic runny nose and loss of smell due to snorting cocaine

• Changes to the reward circuit in the brain, which controls the ability to feel pleasure (such as the effects of cocaine)

• Depression, fatigue, insomnia and other withdrawal symptoms

• Risk of cocaine overdose

Protecting your vision

Vision care is crucial, especially when the eyes are (or have been) exposed to drugs. Recovery can be a challenge in general, but there are specific things you can do to protect your vision, such as:

• Avoid drug use

• Don’t touch your eyes during or after handling substances such as drugs

• Tell your eye doctor about any history of drug use

• Have routine eye exams to keep your eyes healthy 

Annual eye exams are important for everyone for both routine and preventative care. Using cocaine can put you at a higher risk for certain eye conditions, which makes exams all the more important.

If it’s been a while since your last appointment, or if you believe you are experiencing cocaine-related eye problems, don’t hesitate to contact your eye doctor.

Seeking help and recovery

There is help available for cocaine addiction and substance abuse. Many programs involve behavioral therapy, including:

• Recovery groups

• Therapeutic recovery centers or rehabilitation 

• Cognitive-behavioral techniques

• Contingency management, in which patients are rewarded for remaining sober

If you or a loved one is experiencing drug abuse, seeking positive support is one of the best first steps in the recovery process. It’s also important to take care of your health following any history of cocaine use — including the health of your eyes.

Page published on Tuesday, December 5, 2023

Page updated on Tuesday, December 12, 2023

Medically reviewed on Monday, December 4, 2023