Characterization of Infectious Keratitis in Opioid Users in a County Hospital Setting

Abstract

Purpose: The aim of this study was to determine risk factors and clinical course of corneal ulcers in the setting of opioid use. Methods: A retrospective cohort study was performed of patients presenting with bacterial or fungal keratitis at a county hospital from 2010 to 2021. Subjects were separated into 3 groups: opioid drug users (heroin, methadone, and fentanyl), nonopioid drug users, and nondrug users. Twenty-four opioid users, 77 nonopioid drug users, and 38 nondrug users were included in the study. Chi-square and t-tests were used to compare hospitalization for corneal ulcer treatment, length of hospitalization, loss to follow-up, final best-corrected visual acuity (BCVA), medication noncompliance, time to ulcer resolution, and visual disability (defined by either the legal limit for driving in California or the federal limit for blindness). Results: Opioid users had higher rates of unemployment (P = 0.002), homelessness (P = 0.018), and psychiatric conditions (P = 0.024) compared with nonopioid and nondrug users. They had more severe presentations, with worse initial BCVA of the affected eye (P = 0.003), larger ulcer size (P = 0.023), and higher rates of individuals below the legal vision thresholds for driving (P = 0.009) and blindness (P = 0.033) at initial presentation. Opioid use was associated with increased rates of hospitalization (P < 0.001), higher fortified antibiotic use (P = 0.009), worse final BCVA of the affected eye (P = 0.020), and increased rates of BCVA worse than the legal vision thresholds for driving (P = 0.043) and blindness (P < 0.001) on final presentation. Conclusions: Infectious keratitis associated with opioid use is associated with more severe presentations and poorer outcomes, including higher rates of visual disability.