The raging opioid epidemic in the United States should cause ophthalmologists to cast a suspicious look on patients seeking care for red and sore eyes, which could indicate a problem far worse than a minor eye infection.
This is the conclusion reached by ophthalmologists whose new research showed a 400% increase in drug users’ hospital admissions for a rare and dangerous eye infection over a 13-year period. The infection known as endogenous endophthalmitis is caused by bacteria or fungi that enter the bloodstream and often can get towards the eyes when IV drug addicts use dirty needles.
The study, published in the journal JAMA Ophthalmology, highlighted how the ongoing opioid epidemic, which is responsible for two in three overdose deaths in the US, is affecting eyesight, among other aspects of health and well-being.
“We’re used to seeing people with inflammation in our eyes, but now we’re much more likely to ask questions and diagnose infections that camouflage themselves in this way,” said study author David Hinkle, MD. He is an associate professor of ophthalmology and visual sciences at the West Virginia University School of Medicine at Morgantown.
“You can’t tell who an opiate addict is these days – they’re just the normal people in our lives,” said Dr. Hinkle to Medical Daily. “There’s no specific age, body type, or income level, and they’re not particularly willing to use opiates. We need to maintain what is known as a high index of suspicion, not only among young people but also among middle-aged and elderly people. ”
Changing the dynamics around opioids
More than 10 million people in the US, ages 12 and older, used opioids in 2017-18, including 808,000 who used heroin, according to the US Department of Health.
Dr. However, Hinkle noted that after 2010, a greater number of prescription opioid addicts turned to cheaper and more readily available street heroin and synthetic opioids such as fentanyl, which are typically injected. At this point, regulators began to monitor doctors’ prescribing habits for opioids more closely. The relief from many states’ needle exchange programs at the same time also helped share dirty needles, he said.
Dr. Hinkle and colleagues reviewed the national hospital’s inpatient data from 2003 to 2016. More than 56,800 patients were hospitalized with a diagnosis of endogenous endophthalmitis during that period, and 13.7% had a history of drug addiction or drug use.
About 56% of all patients with this infection were white, while 13.6% were black and 10.6% were Hispanic. The mean age of drug using patients was in their late forties, and 62% were men.
The prevalence of endogenous endophthalmitis in hospitalized patients associated with drug use or dependence quadrupled during the study period. In addition, the increase was seen in all regions of the United States.
Eyes particularly vulnerable
While bacteria or fungi entered the bloodstream through dirty needles can infect many organs, the eyes are particularly vulnerable because they are rich in blood vessels, explained Dr. Hinkle.
“The fundus has the highest blood flow for the mass of material that is there than any area in the body,” he said. “Organisms tend to get caught up there because it’s the end of the line to the blood vessels.” worried. Even if you are treated for this infection, you can still be blinded by scars from the infection that is destroying the retina. ”
Abdhish Bhavsar, MD, a clinical spokesperson for the American Academy of Ophthalmology, agreed that the study highlights the need for ophthalmologists to keep an eye out for patients who do not mention drug use but are present with sore eyes.
“Inflammation of the eye can be both non-infectious and infectious, so doctors should maintain a high level of suspicion and inquire about intravenous drug use in particular,” said Dr. Bhavsar, director of the Minneapolis Retina Center.
“We all have prejudices and doctors need to recognize their prejudices just like everyone else,” he added. “We need to be aware of how bias can prevent us from making a diagnosis or not.”
Dr. Bhavsar also advised people taking IV drugs to contact their doctors.
“People shouldn’t be ashamed of telling their doctors,” he said, “because the care they receive can be so much more accurate when the treating doctor knows this information.”
Maureen Salamon writes about health and medicine for websites, magazines, and hospitals such as Medscape, St. Jude Children’s Research Hospital, Weill Cornell Medicine, and others.