Endogenous Endophthalmitis and Other Ocular Manifestations of Injection Drug Use

Preston M. Luong; Edmund Tsui; Nikhil N. Batra; Michael E. Zegans


Curr Opin Ophthalmol. 2019;30(6):506-512. 

In This Article

Abstract and Introduction


Purpose of review: The United States has experienced a dramatic rise in opioid and injection drug use over the past 2 decades. A public health emergency was declared in 2017 and subsequently, there have been several new reports on the rise of endogenous endophthalmitis specifically associated with injection drug use. The purpose of this review is to provide a current perspective of the ocular harms posed by injection drug use.

Recent findings: The opioid epidemic has prompted several new studies from New England, one of the US regions most heavily affected, that examine the trends and characteristics of injection drug use-associated endogenous endophthalmitis. Patients may delay seeking care and may be infected with a variety of rare and atypical microbes, and as a result clinical appearance may vary widely. Injection drug use also leads to embolic phenomena such as talc retinopathy and septic emboli from endocarditis. HIV is highly associated with injection drug use and although HAART has drastically reduced the morbidity and mortality of HIV-associated infections, a variety of ocular disease may accompany an immunocompromised patient.

Summary: Healthcare providers must remain vigilant in the recognition of injection drug use patients with vision loss and ocular inflammation to ensure prompt medical and/or surgical treatment.


The ongoing opioid epidemic represents a serious public health concern in the United States. The rate of opioid-related overdose deaths has increased by over three-fold in the past 2 decades, rising from 9489 deaths per year in 2001 to 42 245 deaths per year in 2016 with the most vulnerable age group of ages 24–35 years. One-fifth of total deaths in this age group was attributed to opioid abuse.[1] Consequently, the opioid epidemic was declared a public health emergency by the US Department of Health and Human Services in October 2017. Furthermore, increases in injection drug use have been accompanied by increases in the rates of associated infections, such as HIV, hepatitis C, endocarditis, and osteomyelitis. In addition to systemic infection, ocular involvement has become more prevalent as the rates of opioid abuse continue to rise. Notably, IDUs may develop endophthalmitis, embolic complications, and HIV-associated infections as a result of introducing external particulate and pathogens into their bloodstreams.[2,3] Within the past 5 years, there have been several recently published series on injection drug use-associated endogenous endophthalmitis (Table 1).[4–7] This review seeks to highlight known ocular complications from injection drug use.