title: Ocular effects and detection in tears of aerosolized intranasal cocaine and fluorescein.
abstract: Ocular effects of intranasal cocaine were investigated. Twenty-nine outpatients from an otolaryngology clinic received 1 mL of aerosolized cocaine 4% (40mg) in each nostril. Intraocular pressure, corneal sensitivity, pupil size, and tear cocaine concentration were assessed before and after cocaine administration. Pupil size was unchanged; intraocular pressure increased in 75% of patients (not statistically significant). Corneal sensitivity decreased by 11% (P less than .05). Cocaine, however, was not detectable in tears using high-performance liquid chromatography. Since corneal sensitivity decreases after intranasal cocaine administration, it may travel retrograde through the nasolacrimal duct. In addition, three pathways of pharmacologic absorption using fluorescein were explored because of its ease of detection. We measured tear fluorescein concentrations in five patients undergoing intravenous angiograms with fluorescein 25% and in six patients who received aerosolized fluorescein 2% intranasally. Fluorescein concentration was 29 times higher per mg dose in intranasal subjects. This finding suggests that reflux occurs through the nasolacrimal duct.
authors.affiliation: Department of Ophthalmology, Tulane University School of Medicine, New Orleans, LA 70112.
authors.forename: M E
authors.initials: ME
authors.lastname: Orlick
authors.forename: P R
authors.initials: PR
authors.lastname: Kastl
authors.forename: P B
authors.initials: PB
authors.lastname: Donzis
authors.forename: R
authors.initials: R
authors.lastname: Howard
authors.forename: J
authors.initials: J
authors.lastname: Rice
authors.forename: S
authors.initials: S
authors.lastname: Tauber
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003042:Cocaine / Q000008:administration & dosage / Q000378:metabolism / Q000494:pharmacology*; D003315:Cornea / Q000187:drug effects; D005123:Eye / Q000187:drug effects*; D019793:Fluorescein; D005451:Fluorescein Angiography; D005452:Fluoresceins / Q000008:administration & dosage / Q000378:metabolism / Q000494:pharmacology*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D008875:Middle Aged; D011680:Pupil / Q000187:drug effects; D013666:Tears / Q000378:metabolism*
chemical_list: D005452:Fluoresceins; D003042:Cocaine; D019793:Fluorescein