Bilateral Optic Neuropathy and Osteolytic Sinusitis

Abstract

COCAINE is a naturally occurring alkaloid of the coca plant<i>Erythroxylon coca</i>. Its psychopharmacological properties are due to stimulation of the central and sympathetic nervous systems by augmentation of the normal effects of the neurotransmitter norepinephrine. The Incas chewed coca leaves prior to 1000ADto "satisfy the hunger, provide the weary and fainting with new vigor and cause the unhappy to forget their miseries."¹ Recent increases in the production, trafficking, and use of cocaine have brought concomitant increases in associated medical problems.^2,3 The usual routes of illicit cocaine use are intranasal, intravenous, and inhalational. Each has unique medical hazards.^4,5We describe a patient with unusual ophthalmic and otolaryngologic complications related to long-term intranasal abuse of cocaine. <h3>Report of a Case</h3> A 43-year-old man was referred to the Neuro-ophthalmology Service with bilateral decreased visual acuity and asymmetric optic nerve head swelling. The patient had noticed progressive