title: Acute angle closure glaucoma precipitated by intranasal application of cocaine.
abstract: We describe a patient who developed acute angle-closure glaucoma following the application of topical intranasal cocaine. A 46-year-old woman underwent an elective antral washout under general anaesthesia and with local application of 25 per cent cocaine paste to the nasal mucosa. Twenty-four hours post-operatively the patient developed sudden painful blindness which was found to be due to acute glaucoma. Cocaine with its indirect sympathomimetic activity causes mydriasis, that can precipitate acute angle-closure glaucoma in predisposed individuals with a shallow anterior chamber. Although the incidence is rare, otolaryngologists need to be aware of this potential complication.
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Royal Gwent Hospital, Newport, Gwent. ckhari@bigfoot.com
authors.forename: C K
authors.initials: CK
authors.lastname: Hari
authors.forename: D G
authors.initials: DG
authors.lastname: Roblin
authors.forename: M I
authors.initials: MI
authors.lastname: Clayton
authors.forename: R G
authors.initials: RG
authors.lastname: Nair
mesh_terms: D000208:Acute Disease; D000281:Administration, Intranasal; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D003042:Cocaine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000139:chemically induced*; D006801:Humans; D007049:Iatrogenic Disease; D008875:Middle Aged; D010254:Paranasal Sinus Diseases / Q000628:therapy; D012852:Sinusitis / Q000628:therapy
chemical_list: D000779:Anesthetics, Local; D003042:Cocaine