Acute angle closure glaucoma precipitated by intranasal application of cocaine

We describe a patient who developed acute angle-closure glaucoma following the application of topical intranasal cocaine. A 46-year-old woman underwen t an elective antral washout under general anaesthesia and with local appli cation of 25 per cent cocaine paste to the nasal mucosa, Twenty-four hours post-operatively the patient developed sudden painful blindness which was f ound to be due to acute glaucoma. Cocaine with its indirect sympathomimetic activity causes mydriasis, that can precipitate acute angle-closure glauco ma in predisposed individuals with a shallow anterior chamber. Although the incidence is rare, otolaryngologists need to be aware of this potential co mplication.