Cocaine-induced ocular toxicity is an increasingly acknowledged but often underestimated clinical condition that includes a wide range of eye-related symptoms. The extensive recreational use of cocaine, together with its powerful sympathomimetic and vasoconstrictive effects, leads to various ocular problems that can impact all anatomical components of the eye. This narrative review aims to deliver a thorough and current synthesis of the existing research on the epidemiology, pathophysiology, clinical symptoms, and therapy of cocaine-related ocular illness. Evidence suggests that cocaine-induced ocular damage involves vascular, local toxic, neuronal, and immunological processes. Reported manifestations in the literature include the ocular surface, optic nerve, posterior segment, orbit, and adnexal tissues. Novel imaging techniques have revealed subclinical retinal microvascular changes in chronic users, suggesting a continuum from initial vascular dysregulation to manifest ischemic injury.

Notwithstanding increased awareness, the existing evidence is constrained by heterogeneity, small sample sizes, and a prevalence of case reports. A comprehensive understanding of the pathophysiological mechanisms and long-term ocular effects is crucial for enhancing diagnostic precision, directing management, and informing preventive measures. Enhanced multidisciplinary collaboration between ophthalmologists and addiction experts is essential to tackle this intricate and dynamic clinical dilemma.