Addiction and Eye Health

Addiction and Eye Health | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Addiction and Eye Health Yosra Mahmoud El Makromy Mohamed, Afaf Hassan Rashwan, Reda Mohammed Ismail, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7612481/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The growing prevalence of substance use disorders has heightened interest in their systemic complications. This study aimed to evaluate the ocular effects associated with substance use among patients at El Abbasiya Mental Health Hospital and the Psychiatry Department of Al-Zahraa University Hospital. Methods This cross-sectional analytical study included 300 patients recruited from El Abbasiya Mental Health Hospital (Ophthalmology Department) and Al-Zahraa University Hospital (Psychiatry Department). All participants were diagnosed with addiction according to DSM-5 criteria, assessed using the Addiction Severity Index (ASI), and underwent a comprehensive ophthalmic examination. Results Hallucinations were most common among alcohol users, while disturbed vision, dryness, keratitis, and corneal ulceration were most frequently observed in nicotine users. Diplopia was most prevalent among individuals using cough medications. Alcohol, poly-substance use, methamphetamine, and cough medications were associated with higher rates of visual disturbances, conjunctival changes, eyelid dysfunction, and fundus abnormalities. Opioid use was notably linked to a higher prevalence of constricted pupils. Differences in visual impairment across varying frequencies and durations of substance use were not statistically significant. According to the ASI, mild complications were reported in 35 patients (11.67%) in the medical domain and in 107 patients (35.67%) in the psychiatric domain. Despite the high prevalence of substance use, no significant association was found between ophthalmic complications and either the frequency or duration of substance use. This may be attributed to the relatively small and selective sample, as well as the use of a specific questionnaire. Conclusions Substance use is significantly associated with a broad spectrum of ocular complications, with distinct substances producing characteristic patterns of eye involvement. Addiction Eye Health Substance Figures Figure 1 Background The eye is a fluid-filled, spherical organ composed of three tissue layers [1] .The neurons of the neural retina translate the visual information into nerve impulses, which travel through the optic nerve to the brain. The photoreceptors, the bipolar cells and the ganglion cells form a direct pathway to the brain [2]. Substance use disorder (SUD) is described in DSM-5 under "Substance-related and addictive disorders," replacing the outdated term "abuse" found in DSM-III-R. It includes both substance use and substance/medication-induced mental disorders [3]. The rise in SUDs has led to an increased interest in studying their systemic complications. The ocular manifestations often remain under-recognized. The eyes, being highly vascular and neurologically rich structures, are particularly vulnerable to the toxic effects of various substances, both licit and illicit [4]. Substances such as opioids, methamphetamine (Meth), alcohol, cannabis, and others have been reported to cause a wide range of ocular issues—from mild symptoms like dryness and conjunctival injection to severe complications such as optic neuropathy, retinal detachment, or irreversible vision loss [5]. Diplopia may result from alcohol, phencyclidine, barbiturates, or heroin use. Phencyclidine and cocaine can cause corneal anaesthesia and keratitis, while alcohol and nicotine are linked to dry eye. Mydriasis is often induced by cocaine, methamphetamine, LSD, or marijuana, whereas heroin causes miosis. Barbiturates are associated with hippus or an indistinct pupillary response. Nicotine use has been implicated in non-arteritic optic neuropathy, thyroid orbitopathy, and raised intraocular pressure, and both alcohol and nicotine contribute to age-related macular degeneration. Cocaine, methamphetamine, and opioids may lead to retinal venous occlusion and intraretinal haemorrhage, and methamphetamine and heroin are associated with talc retinopathy. Toxic optic neuropathy has been reported with nicotine and methanol, while phencyclidine, barbiturates, and morphine may cause nystagmus. Impaired oculomotor function has been observed with cannabinoid use, palinopsia with LSD, and decreased intraocular pressure with cannabinoids [6]. These effects may result from direct toxic damage, vascular compromise, immune-mediated mechanisms, or secondary to systemic effects of the substances. The degree and type of ocular involvement may also vary depending on the duration, frequency, and combination of substance use [7]. The clinical studies examining these associations, particularly in the Egyptian population, are limited. Most available literature focuses on isolated case reports or specific substances, leaving a significant gap in understanding the broader patterns of ocular pathology related to addiction [8]. The aim of this work was to assess ocular side effects due to substance use at El Abassya Mental Health Hospital and the Psychiatry Department at Al-Zahraa University Hospital. Methods This cross-sectional analytical study was conducted on 300 patients recruited from the Ophthalmology Department, El Abbasiya Mental Health Hospital, and the Psychiatry Department, Al-Zahraa University Hospital, between December 2023 and June 2024. Written informed consent was obtained from all participants. The study was approved by the Ethics Committee of the Faculty of Medicine, El Abbasiya Mental Health Hospital, and Al-Zahraa University Hospital. Inclusion criteria were history of substance use, both male and female participants, age between 18 and 50 years and absence of intoxication or withdrawal symptoms for at least four weeks prior to enrolment. Exclusion criteria were general systemic comorbidities (e.g., diabetes mellitus, hypertension) and previous history of ocular pathology or ocular surgery. Data collection included a detailed history including sociodemographic data including substance use history: onset, duration, type, frequency, history of intoxication, withdrawal episodes, and attempts to quit, types of substances used: cigarettes/shisha, hashish, methamphetamine, alcohol, opioids, gabapentin, and cough medications, medical history and family history including relevant medical or psychiatric conditions, including substance use patterns. Clinical diagnosis of addiction was established according to DSM-5 criteria by senior staff [9]. Addiction severity index (ASI): The ASI, a semi-structured interview assessing multiple domains (medical, psychiatric, family, legal, social, and drug use), was used to determine the relationship between substance use severity and ocular pathology [10]. Ophthalmic examination included: Visual acuity assessment using Landolt’s chart, ocular motility examination, slit-lamp examination of the eyelid, conjunctiva, and anterior segment (cornea, anterior chamber, iris, lens), pupil examination, intraocular pressure measurement using Goldmann applanation tonometry, fundus examination using a +90 D lens (slit-lamp biomicroscopy) and indirect ophthalmoscopy and additional investigations: visual field testing and optical coherence tomography (OCT). Figure 1 shows the examination and the follow-up of a case with conjunctival congestion, sever dryness, which showed significant, advanced visual field loss, particularly in the superior field. Statistical analysis: Statistical analysis was done by SPSS v26 (IBM Inc., Armonk,NY,USA). Quantitative variables were presented as mean and standard deviation (SD) . Qualitative variables were presented as frequency and percentage (%). Qualitative variables were presented as frequency and percentage (%) and were analysed utilizing the Chi-square test. A two tailed P value < 0.05 was considered statistically significant. Results The mean age was 32.96 ±8.08. The mean duration of substance use by years was 7.14 ± 3.65. the most common sex was male 212 (70.7%). Working was the occupation of the study participants 241 (80.33%). The most marital status was married155 (51.7%). The most residence was rural 152 (50.7%). Methamphetamine was the most type of substance use (19%). The most frequency of use of Alcohol is twice daily by 12 patients (44.4%). Among nicotine users, 12 patients (48.0%) used it once daily. The most frequency of poly substance use is Twice daily by 22 patients (39.3%). The most frequency of use of Gabapentin is Twice daily by 8 patients (50.0%). The most frequency of use of Opioid is once daily by 22 patients (40.0%). The most frequency of use of Hashish is once or twice daily by 18 patients (36.7%). The most frequency of use of Methamphetamine is twice daily by 22 patients (38.6%). The most frequency of cough medication is twice daily by 8 patients (53.3%) . Table 1 Table 2 shows addiction severity index of the studied participants. Regarding ASI, mild complications were reported in 35 patients (11.67%) in the medical domain, in 107 patients (35.67%) in the psychiatric domain, in 96 patients (32%) in the family domain, in 86 patients (28.67%) in the legal domain, in 44 patients (14.67%) in the social domain and in 141 patients (47%) in the dug domain. Table 3 Despite the variations in symptoms across the different frequency groups, the differences in ocular manifestations covering vision, eyelid involvement, dry eye symptoms, conjunctival inflammation, corneal pathology, pupil abnormalities, fundus findings, and IOP status—were not statistically significant (P > 0.05). Table 4 Across most ophthalmological abnormalities, differences between short-term (<1 year) and long-term (≥1 year) substance users were modest, with no statistically significant differences. Table 5 Discussion Addiction and substance abuse are major worldwide public health issues that have an impact on almost all bodily organ systems, including the eyes. Because they are extremely vascular and neurologically complex organs, the eyes are especially susceptible to the harmful effects of many substances, both licit and illicit [11]. Misusing certain substances can have serious adverse effects on the eyes ranging from dilated pupils related to alcohol consumption to vision loss, which may be associated with intravenous drug misuse. Thus, the type and severity of the ocular manifestations brought on by substance use depend on the substance, the method of use, and individual health factors [12]. Demographic factors play a foundational role in shaping patterns of substance use and addiction across different populations. Age, gender, socioeconomic status, education, employment, and geographic location all interact with an individual's risk for initiating and maintaining substance use. Young adults, particularly those between the ages of 18 and 35, represent a consistently high-risk group for the onset of substance use. In the current study, participants ranged in age from 20 to 50 years, with a mean ± standard deviation of 32.96 ± 8.08 years. This period of life is often marked by exploration, identity formation, peer influence, and stress related to academic, occupational, or financial challenges—all of which can increase susceptibility to experimenting with or regularly using addictive substances [13]. In the current study, the mean duration of substance use was 7.14 ± 3.65 years. This is in line with the findings of Poudel and Gautam [14], who reported a median duration of 27 years from first to last use and a median of 9 years from first treatment to last use, underscoring the chronic and prolonged nature of substance use in many individuals. According to our results, the substances of abuse, arranged from most to least common, were: methamphetamine (19%), poly-substance use (18.7%), opioids (18.3%), hashish (16.3%), alcohol (9%), nicotine (8.3%), gabapentin (5.3%), and cough medication (5%). According to Elrassas et al. [15], qualitative urine drug screening revealed that the most commonly detected substance was cannabinoids (53%), followed by synthetic cannabinoids (22%) and Meth (19%). In terms of self-reported substance use, cannabinoids were again the most prevalent (96%), followed by alcohol (38%) and synthetic cannabinoids (33%). Negm and Fouad [16] identified tramadol, cannabis, and alcohol as the most prevalent substances among adolescent school students in Zagazig. . In terms of demographics, 70.7% of participants in the present study were male (n = 212), while 29.3% were female (n = 88). Regarding employment status, 241 participants (80.33%) were employed, whereas 59 (19.67%) were unemployed. Marital status showed that 109 participants (36.3%) were single, 36 (12.0%) were divorced, and 155 (51.7%) were married. The study population was almost evenly divided between urban (n = 148, 49.3%) and rural (n = 152, 50.7%) residents. These findings align with those reported by Lev-Ran et al. [17] who examined demographic differences in the prevalence of substance use disorders (SUDs) among individuals with lifetime exposure to various substances.Gender disparities in substance use behaviors are well-documented, with men consistently reporting higher rates of alcohol, tobacco, and illicit drug use. These differences have been shaped historically by sociocultural norms, peer influences, and gender-specific expectations, which have often rendered substance use more socially acceptable or even encouraged among males. Biological and psychological factors also play a role, including variations in drug metabolism, levels of impulsivity, and coping strategies. In addition Female addicts in Egypt tend to use drugs in secrecy, as this conflicts with cultural traditions and societal morals. Nevertheless, the rate of addiction among girls and women is on the rise. According to the ASI, findings across multiple domains revealed varying levels of complications among patients. In the medical domain, mild complications were reported in 35 patients (11.67%), moderate issues in 28 (9.33%), and severe medical conditions in 15 (5%). These findings are partially consistent with those of Abouzed et al. [18] who reported that, according to the Addiction Severity Index, most cases demonstrated severe drug and alcohol use, along with severe psychiatric, social, medical, and legal problems related to substance dependence. The relatively lower detection of medical complications may be attributed to the index's focus on chronic health conditions (such as diabetes mellitus and hypertension) Ocular manifestations: Understanding the larger patterns of ocular pathology linked to addiction is severely lacking because the majority of the research currently in publication concentrates on individual case reports or particular substances. It is clinically and socially critical to close this gap since vision loss affects both functional independence and quality of life [8] . Opioids, Meths, alcohol, cannabis, and other substances have been linked to a variety of eye problems, ranging from minor symptoms like dry eyes and conjunctival injection to serious consequences like optic neuropathy, retinal detachment, or permanent blindness. These consequences could be secondary to the drugs' systemic effects, immune-mediated processes, vascular impairment, or direct toxic harm. The length, frequency, and combination of substance use may also affect the type and degree of ocular involvement [19]. Ophthalmological findings: Although there is growing evidence of the consequences of substance use on the eyes, there are few thorough clinical investigations looking at these relationships, especially in the Egyptian population. Vision: Among the patients revealed a range of visual and eye-related complications. Regarding visual disturbances, hallucinations were reported in 87 patients (29.0%), disturbed vision in 64 patients (21.3%), loss of vision in 47 patients (15.7%), and diplopia (double vision) in 44 patients (14.7%). In the present study, alcohol, nicotine, polysubstance use, Meth, and hashish were significantly more associated with visual abnormalities compared to opioids, gabapentin, and cough medications (P < 0.001). In Egypt, this trend is considered a significant public health risk, as the prevalence of methamphetamine,alochol and cannabis use is increasing among youth and drivers, contributing to a rise in road traffic accidents. The underlying pathophysiology typically involves overstimulation or dysregulation of key neurotransmitter systems namely dopamine, serotonin, and glutamate within the brain’s visual processing centers. For example, stimulants such as Meth may induce hyperdopaminergic states, leading to psychosis-like symptoms, whereas substances like cannabis and alcohol are known to distort visual perception by disrupting cortical activity and impairing visual integration [20]. Eyelid and anterior segment: In our study, a wide range of ocular complications were observed among substance users. Eyelid abnormalities included ptosis (drooping eyelid) in 29 patients (9.7%), blepharitis in 111 (37.0%), and laceration with chemosis in 22 (7.3%). Ocular dryness was the most frequently reported symptom, affecting 186 patients (62.0%). Pupillary abnormalities were also common, with pupil dilation observed in 123 patients (41.0%) and constriction in 51 patients (17.0%). Conjunctival involvement included conjunctival injection in 99 patients (33.0%), mucopurulent conjunctivitis (MPC) in 76 (25.3%), follicular conjunctivitis in 54 (18.0%), and trachoma-like findings in 60 patients (20.0%). Corneal complications were reported in 163 patients (54.3%), primarily in the form of keratitis and corneal ulcers. Substance-specific associations: Statistical analysis revealed several substance-specific associations: Eyelid abnormalities were significantly more prevalent among users of alcohol, methamphetamine, cough medications, and poly-substances compared to those using opioids, gabapentin, hashish, and nicotine ( P < 0.001). Ocular dryness was significantly more common in individuals using nicotine, cough medications, and poly-substances than in those using alcohol, opioids, gabapentin, hashish, or methamphetamine ( P < 0.001). Keratitis and corneal ulcers were more frequently associated with alcohol, nicotine, and opioid use than with other substances ( P < 0.001). Pupil dilation was significantly more prevalent in users of cough medications and methamphetamine, while pupil constriction was predominantly seen in opioid users ( P < 0.001). Conjunctival changes (e.g., injection, MPC, and trachoma-like features) were significantly higher among users of alcohol, methamphetamine, cough medications, and poly-substances ( P < 0.001). Structural and functional changes in the anterior segment of the eye—such as ptosis, dryness, and conjunctival inflammation were particularly pronounced among users of certain substances. Drooping eyelids were notably associated with alcohol, Meth, cough mixtures, and poly-substance use, likely reflecting both neuromuscular and dermatologic involvement [21]. A meta-analysis by Xu et al. [22] further supports this association, demonstrating that tobacco smoking significantly increases the risk of dry eye due to impaired tear production and glandular dysfunction. Conjunctival inflammation, including injection and MPC, was frequently observed among users of stimulants and alcohol. This aligns with a case report by Isaak and Liesegang [23], which described severe conjunctival and episcleral redness in a stimulant-injecting patient. The mechanisms likely include direct irritation from toxic substances, poor hygiene, immune dysregulation, and exposure to environmental pathogens [24, 25]. These results align with a retrospective cohort study by Lopez et al. [26], revealed more severe presentations, including larger ulcers, poorer baseline visual acuity, and worse final outcomes compared to non-users. Posterior segment findings and intraocular pressure abnormalities: In our study, posterior segment complications were significantly more common among individuals using alcohol, poly-substances, cough medications, and Meth than those using opioids, gabapentin, hashish, or nicotine (P < 0.001). Specific fundus pathologies included ARMD in 76 patients (25.3%), optic neuropathy in 64 (21.3%), retinal detachment in 13 (4.3%), and RVO in 20 (6.7%). These posterior segment disorders are likely multifactorial in origin, involving toxic optic nerve injury, retinal ischemia, and oxidative stress. Methamphetamine has been specifically associated with retinal vascular compromise and ischemia, while chronic alcohol intake is a known risk factor for nutritional optic neuropathy [27]. Intraocular pressure (IOP) and pupillary changes: Significant alterations in intraocular pressure (IOP) and pupillary responses were also documented: Hypotony was more frequently observed in hashish users compared to other substance groups ( P = 0.001), potentially reflecting cannabinoid-induced suppression of aqueous humor production. Pupil dilation was significantly more common among methamphetamine and cough medication users, consistent with the sympathomimetic effects of stimulants and decongestants. In contrast, pupil constriction was predominantly seen in the opioid group, aligning with the well-known miotic effects of opioids ( P < 0.001). These findings underscore the diverse ocular effects of different substances and the importance of considering both systemic and local mechanisms of ocular involvement [28]. Ophthalmological finding caused by substance use: Vision included Hallucinations with Alcohol (59.3%), disturbed vision with Nicotine (80%), loss of vision with Opioid (27.3%) and Diplopia with cough medication (80%). Eyelid included Dropped eyelid with Alcohol (63.0%), Blepharitis with cough medication (66.7%) and laceration & chemosis with Hashish (12.2%). Dry eye included Dryness with Nicotine (96%). Conjunctiva included conjunctival injection with Hashish (51.0%), MPC with cough medication (46.7%), follicular conjunctivitis with Nicotine (20%) and trachoma in poly substance use (28.6%). Cornea included Keratitis & corneal ulcer with Alcohol (70.4%). Pupil included dilated with Methamphetamine (89.5%) and constricted in opioid (72.7%). Intraocular pressure (IOP) included Hypotony with Hashish (81.6%). Fundus included ARMD with Nicotine (84%), optic neuropathy with Opioid (45.5%), retinal detachment with Alcohol (7.4%) and retinal vein occlusion (RVO) with Opioid (20.0%). The study demonstrates that substance use is associated with a wide spectrum of ophthalmological abnormalities, many of which can significantly impair vision and overall quality of life. Nicotine, alcohol, opioids, methamphetamine, hashish, and cough medications each showed a dominant association with specific, often severe, eye conditions. Notably, nicotine use was strongly linked to high rates of ocular surface dryness (96%) and age-related macular degeneration (84%), indicating a substantial long-term threat to vision. Alcohol use showed the highest association with visual hallucinations and corneal disease, while opioids were most strongly linked to optic neuropathy and pupil constriction, both of which can result in irreversible vision loss. Methamphetamine use was associated with a markedly high prevalence of pupillary dilation (89.5%), and hashish use was strongly related to ocular hypotony (81.6%), a potentially vision-threatening condition . These findings highlight that substance use not only poses serious risks to general health but also exerts profound and varied adverse effects on ocular health, underlining the need for early detection, targeted prevention, and multidisciplinary management strategies. Smoking has been associated with a variety of ocular surface disturbances. These include alterations in the conjunctival flora, ocular irritation, conjunctival redness, dry eye symptoms, ocular surface inflammation, and meibomian gland dysfunction [29]. One of the most consistent findings is a reduction in tear film breakup time, indicating tear film instability. While Schirmer’s test results may vary—being normal, decreased, or paradoxically elevated—this variation often reflects reflex tearing in response to surface irritation rather than adequate baseline tear production [30]. Regarding the daily frequency of substance use, 44.4% of alcohol users reported consuming alcohol twice daily). Increased alcohol consumption and its negative effects on the eyes, depending on its duration in the bloodstream, and frequencz of use will lead to many disasters and accidents, which will in turn affect the health of the community. Among nicotine users, 12 patients (48.0%) used it once daily. For poly-substance users, 22 patients (39.3%) reported twice-daily use, while 18 patients (32.1%) used substances three times daily. Among gabapentin users, 5 patients (31.3%) reported once-daily use and 8 (50.0%) used it twice daily. Opioid users reported varying frequencies, with 22 patients (40.0%) using once daily and 17 (30.9%) using three times per day. Hashish use was distributed as follows: 18 patients (36.7%) used it once or twice daily, and 13 patients (26.5%) used it three times per day. Methamphetamine was used twice daily by 22 patients (38.6%) and three times daily by 18 (31.6%). Among cough medication users, 8 patients (53.3%) reported twice-daily use. Overall, the frequency of daily substance use did not differ significantly across the various substance groups in the studied sample (P > 0.05). Despite the variations in reported symptoms across the different frequency groups, the differences in ocular manifestations covering vision, eyelid involvement, dry eye symptoms, conjunctival inflammation, corneal pathology, pupil abnormalities, fundus findings, and IOP status—were not statistically significant (P > 0.05). Vision, eye lid, Dry eye, conjunctiva, cornea, pupil, fundus and IOP were insignificantly different between both groups. The findings reveal a clear trend: higher daily frequency of substance use is generally associated with increased prevalence of several ophthalmological abnormalities, notably hallucinations, ocular surface dryness, conjunctival injection, keratitis, pupil dilation, and ARMD. Although some conditions, such as loss of vision and hypotony, appeared with similar frequency across use patterns, others showed a dose–response relationship, suggesting cumulative toxic effects on ocular tissues. These results emphasize that not only the type of substance but also the frequency of use significantly influences eye health, compounding the overall burden on both visual function and general health. Ophthalmological findings by duration of substance use: Across most ophthalmological abnormalities, differences between short-term (<1 year) and long-term (≥1 year) substance users were modest, with no statistically significant differences. However, certain trends were noted: long-term users showed higher rates of trachoma and ARMD, indicating cumulative ocular damage over time, while short-term users had slightly higher rates of hallucinations, blepharitis, and pupil dilation, possibly reflecting acute or early toxic effects. These findings suggest that substance use, regardless of duration, poses substantial risks to ocular health, but prolonged exposure may contribute more to chronic structural eye disease, adding to the long-term burden on vision and general health. Alcohol intake in short term leads to dilated pupils, slower pupillary reaction, diplopia, night vision disturbances decreased contrast sensitivity, congested eyes, twitching of eyelid (myokymia) due to excessive intake and nystagmus. Alcohol intake may impair the vision or orientation to visuospatial stimuli due to the various mechanisms. Alcohol intoxication can also impair mesopic rod and cone temporal processing pathways. Chronic intake of alcohol can cause external ophthalmoplegia (due to thiamine deficiency), toxic amblyopia and ARMD [31]. Cigarette smoking is one of the most common and the most alarming health problem today. It can affect multiple structures in the body as well as the eye due to chemical toxicity and free radical-related oxidative damage. Nicotine has been reported to cause alteration of the conjunctival flora, irritation, redness, dry eye, ocular surface inflammation and meibomian gland dysfunction.With chronic use , Smoking increases the risk of squamous metaplasia of bulbar conjunctiva and conjunctival intraepithelial neoplasia. Corneal wound healing is delayed in smokers, increasing the risk of keratitis and poor healing of epithelial defect or ulcer [32]. Opioid use can also significantly affect ocular health, most notably causing miosis (pinpoint pupils), a classic sign of opioid intoxication resulting from parasympathetic stimulation. This pupil constriction can impair vision in low-light environments and may contribute to visual discomfort or blurred vision. Chronic opioid use has been linked to reduced tear production and dry eye symptoms, possibly due to suppression of parasympathetic activity affecting lacrimal gland function. García- García-López et al. [33] noted that chronic opioid users reported a significantly higher incidence of dry eye complaints and visual disturbances, suggesting both neurological and ocular surface involvement. Cannabis intake leads to conjunctival injection, dilated pupils, reduced accommodation amplitude and impaired oculomotor function in chronic users. Impaired oculomotor function can manifest in the form of increase in latency to initiate saccades, impairment in processing of saccades and impaired visuospatial working memory. The limitations of the study were that the relatively small sample size may be contributed to some insignificant results. Conclusions The use of alcohol, methamphetamine, and cannabis among youth represents a substantial public health concern, given the combined neurological, behavioral, and ocular risks associated with these substances. Alcohol impairs visual function, coordination, and cognitive processing, thereby increasing accident risk, while chronic use can result in optic neuropathy. Methamphetamine is associated with severe neurotoxicity, psychiatric complications, and significant ocular effects, including mydriasis, keratitis, and retinal injury. Cannabis use during youth disrupts neurodevelopment, impairs attention and visual perception, and may exacerbate ocular conditions such as conjunctival injection and increased intraocular pressure. Early initiation of these substances heightens the likelihood of dependency, long-term visual impairment, and reduced quality of life, underscoring the urgent need for targeted prevention strategies and ocular health awareness programs in young populations. With further studies to investigate the short- and long-term effects of specific substances on ocular structures. Substance use is significantly associated with a wide range of ocular complications, with specific substances causing distinct patterns of eye involvement. Therefore, we recommend conducting further studies to investigate the short- and long-term effects of specific substances on ocular structures. Additionally, public health awareness should be increased regarding the ocular complications of substance use and its impact on quality of life. Conclusion The use of alcohol, methamphetamine, and cannabis among youth represents a substantial public health concern, given the combined neurological, behavioral, and ocular risks associated with these substances. Alcohol impairs visual function, coordination, and cognitive processing, thereby increasing accident risk, while chronic use can result in optic neuropathy. Methamphetamine is associated with severe neurotoxicity, psychiatric complications, and significant ocular effects, including mydriasis, keratitis, and retinal injury. Cannabis use during youth disrupts neurodevelopment, impairs attention and visual perception, and may exacerbate ocular conditions such as conjunctival injection and increased intraocular pressure. Early initiation of these substances heightens the likelihood of dependency, long-term visual impairment, and reduced quality of life, underscoring the urgent need for targeted prevention strategies and ocular health awareness programs in young populations. With further studies to investigate the short- and long-term effects of specific substances on ocular structures. Substance use is significantly associated with a wide range of ocular complications, with specific substances causing distinct patterns of eye involvement. Therefore, we recommend conducting further studies to investigate the short- and long-term effects of specific substances on ocular structures. Additionally, public health awareness should be increased regarding the ocular complications of substance use and its impact on quality of life. Abbreviations ASI: Addiction Severity Index, SUD: Substance use disorder, OCT :Optical coherence tomography, SD :standard deviation , MPC :Marginal Pupil Conjunctivitis, IOP :Intraocular pressure, ARMD :Age-Related Macular Degeneration , Rvo: Retinal Vein Occlusion, MPC: Marginal Pupil Conjunctivitis. Declarations Ethics approval and consent to participate: The study was approved by the Ethics Committee of the Faculty of Medicine, El Abbasiya Mental Health Hospital, and Al-Zahraa University Hospital .Written informed consent was obtained from all participants. Consent for publication: Written informed consent was obtained from all participants included in the study. Availability of data and materials: Availability of data and material: The data supporting the present findings are contained within the manuscript. Competing interests: The authors declare no competing interests. Funding: The authors declare that no funds, grants, or other support were received for the preparation of this manuscript. Authors' contributions: Conceptualization: A.H.R. &Y.M.E.M., methodology: Y.M.E.M. & R.M.I., Formal analysis and investigation: A.H.R.&R.M.I., Writing—original draft preparation: Y.M.E.M., Writing—review and editing: O.I.A., R.M.I., supervision, validation and final editing: Y.M.E.M.,A.H.R.& R.M.I., all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgements: Not applicable References Agrahari V, Mandal A, Agrahari V, Trinh HM, Joseph M, Ray A, et al. (2016) A comprehensive insight on ocular pharmacokinetics. 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J Clin Med.11:14-24 Tables Table 1: Demographic characteristics, types of substances used, and frequency of use among the study participants (N = 300) Items (n=300) Demographic data Age (years) 32.96 ±8.08 Duration of substance use by years 7.14 ± 3.65 Sex Male 212 (70.7%) Female 88 (29.3%) Occupation Working 241 (80.33%) Not working 59 (19.67%) Marital status Single 109 (36.3%) Divorced 36 (12.0%) Married 155 (51.7%) Residence Urban 148 (49.3%) Rural 152 (50.7%) Type of substance use Alcohol (n= 27) (9%) Nicotine (n= 25) (8.33%) Poly substance use (n= 56) (18.67%) Gabapentin (n= 16) (5.33%) Opioid (n= 55) (18.33%) Hashish (n= 49) (16.33%) Methamphetamine (n= 57) (19%) Cough medication (n= 15) (5%) Frequency of use / day Once 8 (29.6%) 12 (48.0%) 16 (28.6%) 5 (31.3%) 40.0% 18 (36.7%) 17 (29.8%) 4 (26.7%) Twice 12 (44.4%) 5 (20.0%) 22 (39.3%) 8 (50.0%) 16 (29.1%) 18 (36.7%) 22 (38.6%) 8 (53.3%) Triple 7 (25.9%) 8 (32.0%) 18 (32.1%) 3 (18.8%) 17 (30.9%) 13 (26.5%) 18 (31.6%) 3 (20.0%) p-value < 0.001* Data are presented as mean ± SD or frequency (%). MPC: Marginal Pupil Conjunctivitis, IOP: Intraocular pressure, ARMD: Age-Related Macular Degeneration, Rvo: Retinal Vein Occlusion. Table 2: Addiction severity index of the studied participants Items (n=300) Medical Mild 35 (11.67%) Moderate 28 (9.33%) Sever 15 (5%) Psychiatric Mild 107 (35.67%) Moderate 47 (15.67%) Sever 8 (2.67%) Family Mild 96 (32%) Moderate 43 (14.33%) Sever 12 (4%) Legal Mild 86 (28.67%) Moderate 31 (10.33%) Sever 8 (2.67%) Social Mild 44 (14.67%) Moderate 30 (10%) Sever 0 (0%) Drug Mild 141 (47%) Moderate 106 (35.33%) Sever 4 (1.33%) Data are presented as frequency (%). Table 3: Ophthalmological findings among the studied sample according to substance type Type of substance use Alcohol (n= 27) Nicotine (n= 25) Poly substance use (n= 56) Gabapentin (n= 16) Opioid (n= 55) Hashish (n= 49) Methamphetamine (n= 57) Cough medication (n= 15) Vision Hallucinations 16 (59.3%) 0 (0.0%) 31 (55.4%) 0(0%) 0 (0%) 20 (40.8%) 20 (35.1%) 0 (0%) Disturbed vision 2 (7.4%) 20 (80.0%) 7(12.5%) 0(0%) 20 (36.4%) 5 (10.2%) 10 (17.5%) 0 (0%) Loss of vision 4 (14.8%) 0 (0.0%) 6 (10.7%) 0(0%) 15 (27.3%) 7 (14.3%) 15 (26.3%) 0 (0%) Diplopia 5 (18.5%) 0 (0.0%) 11 (19.6%) 11 (68.8%) 0(0%) 3 (6.1%) 2 (3.5%) 12 (80.0%) Normal 0 (0%) 5 (20.0%) 1 (1.8%) 531.3%) 20 (36.4%) 14 (28.6%) 10 (17.5%) 3 (20.0%) p-value < 0.001* Eye lid Dropped eye lid 17 (63.0%) 0 (0%) 12(21.4%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Blepharitis 7 (25.9%) 12 (48.0%) 22 (39.3%) 6 (37.5%) 12 (21.8%) 15 (30.6%) 27 (47.4%) 10 (66.7%) Laceration and chemosis 3 (11.1%) 0 (0%) 5 (8.9%) 0 (0%) 5.5% 6 (12.2%) 5 (8.8%) 0 (0%) Normal 0 (0%) 52.0% 17 (30.4%) 10 (62.5%) 40 (72.7%) 28 (57.1%) 25 (43.9%) 5 (33.3%) p-value < 0.001* Dry eye Dryness 14 (51.9%) 24 (96.0%) 40 (71.4%) 7 (43.8%) 36 (65.5%) 29 (59.2%) 25 (43.9%) 11 (73.3%) Normal 13 (48.1) 1 (4.0%) 16 (28.6%) 9 (56.3%) 19 (34.5%) 20 (40.8%) 32 (56.1%) 4 (26.7%) p-value < 0.001* Conjunctiva Conjunctival injection 12 (44.4%) 13 (52%) 12 (21.4%) 0 (0%) 20 (36.4%) 25 (51.0%) 17 (29.8%) 0 (0%) MPC 5 (18.5%) 5 (20.0%) 13 (23.2%) 6 (37.5%) 10 (18.2%) 10 (20.4%) 20 (35.1%) 7 (46.7%) Follicular conjunctivitis 6 (22.2%) 20.0% 15 (26.8%) 5 (31.3%) 6 (10.9%) 5 (10.2%) 7 (12.3%) 5 (33.3%) Trachoma 4 (14.8%) 2 (8.0%) 16 (28.6%) 5 (31.3%) 10 (18.2%) 9 (18.4%) 11 (19.3%) 3 (20.0%) Normal 0 (0%) 0 (0%) 0 (0%) 0 (0%) 9 0 (0%) 2 (3.5%) 0 (0%) p-value <0.001* Cornea Keratitis and corneal ulcer 19 (70.4%) 20 (80%) 35 (62.5%) 10 (62.5%) 37 (67.3%) 15 (30.6%) 17 (29.8%) 10 (66.7%) Normal 8 (29.6%) 5 (20%) 21 (37.5%) 6 (37.5%) 18 (32.7%) 34 (69.4%) 40 (70.2%) 5 (33.3%) p-value <0.001* Pupil Dilated 17 (63%) 0 (0%) 12 (21.4%) 0 (0%) 0 (0%) 30 (61.2%) 51 (89.5%) 13 (86.7%) Constricted 0 (0%) 0 (0%) 11 (19.6%) 0 (0%) 40 (72.7%) 0 (0%) 0 (0%) 0 (0%) Normal 10 (37.0%) 25 (100.0%) 33 (58.9%) 16 (100.0%) 15 (27.3%) 19 (38.8%) 6 (10.5%) 2 (13.3%) p-value <0.001* IOP Hypotony 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 40 (81.6%) 0 (0%) 0 (0%) Normal 27 (100%) 25 (100%) 56 (100%) 16 (100%) 55 (100%) 9 (18.4%) 57 (100%) 15 (100%) p-value 0.001* Fundus ARMD 10 (37%) 21 (84%) 15 (26.8%) 0 (0%) 7 (12.7%) 9 (18.4%) 6 (10.5%) 8 (53.3%) Optic neuropathy 12 (44.4%) 0 (0%) 10 (17.9%) 0 (0%) 25 (45.5%) 10 (20.4%) 7 (12.3%) 0 (0%) Retinal detachment 2 (7.4%) 0 (0%) 3 (5.4%) 0 (0%) 3 (5.5%) 0 (0%) 5 (8.8%) 0 (0%) Rvo 0 (0%) 0 (0%) 4 (7.1%) 0 (0%) 11 (20.0%) 0 (0%) 5 (8.8%) 0 (0%) Normal 3 (11.1%) 4 (16%) 24 (42.9%) 16 (100%) 9 (16.4%) 30 (61.2%) 34 (59.6%) 7 (46.7%) p-value <0.001* Data are presented as frequency (%), MPC: Marginal Pupil Conjunctivitis, IOP: Intraocular pressure, ARMD: Age-Related Macular Degeneration, Rvo: Retinal Vein Occlusion. * significant as P-value ≤ 0.05. Table 4: Ophthalmological findings among the sample studied according to frequency of substance uses per day Items Frequency of use per day p-value Once (N=102) Twice (N=111) Triple (N=87) Vision Hallucinations 19(18.6%) 37(33.3%) 31(35.6%) 0.160 Disturbed vision 28(27.5%) 19(17.1%) 17(19.5%0 Loss of vision 17(16.7%) 17(15.3%) 13(14.9%) Diplopia 14(13.7%) 20(18.0%) 10(11.5%) Normal 24(23.5%) 18(16.2%) 16(18.4%) Eye lid Dropped eye lid 7 (6.9%) 10(9.0%) 12(13.8%) 0.119 Blepharitis 32(31.4%) 45(40.5%) 34(39.1%) Laceration and chemosis 6(5.9% 12(10.8%) 4(4.6%) Normal 57(55.9%) 44(39.6%) 37(42.5%) Dry eye Dryness 56(54.9%) 71(64.0%) 59(67.8%0 0.164 Normal 46(45.1%) 40(36.0%) 28(32.2%) Conjunctiva Conjunctival injection 24(23.5%) 38(34.2%) 37(42.5%) 0.119 MPC 28(27.5%) 32(28.8%) 16(18.4%) Follicular conjunctivitis 25(24.5% 14(12.6%) 15(17.2%) Trachoma 21(20.6%) 24(21.6%) 15(17.2%) Normal 4(3.9%) 3(2.7%) 4(4.6%) Cornea Keratitis and corneal ulcer 50(49.0%) 61(55.0%) 52(59.8%) 0.330 Normal 52(51.0%) 50(45.0%) 35(40.2%) Pupil Dilated 33(32.4%) 50(45.0%) 40(46.0%) 0.30 Constricted 20(19.6%) 17(15.3%) 14(16.1%) Normal 49(48.0%) 44(39.6%) 33(37.9%) IOP Hypotony 13(12.7%) 16(14.4%) 11(12.6%) 0.91 Normal 89(87.3%) 95(85.6%) 76(87.4%) Fundus ARMD 19(18.6%) 26(23.4%) 31(35.6%) 0.162 Optic neuropathy 23(22.5%) 26(23.4%) 15(17.20%) Retinal detachment 3(2.9%) 6(5.4%) 4(4.6%) Rvo 9(8.8%) 4(3.6%) 7(8.0%) Normal 48(47.1%) 49(44.1%) 30(34.5%) Data are presented as frequency (%). MPC: Marginal Pupil Conjunctivitis, IOP: Intraocular pressure, ARMD: Age-Related Macular Degeneration, Rvo: Retinal Vein Occlusion. Table 5: Ophthalmological findings among the sample studied according to duration of substance uses Duration of substance uses p-value =1 year Vision Hallucinations 72 (30.4%) 15 (23.8%) 0.332 Disturbed vision 51 (21.5%) 13 (20.6%) Loss of vision 38 (16.0%) 9 (14.3%) Diplopia 36 (15.2%) 8 (12.7%) Normal 40 (16.9%) 18 (28.6%) Eye lid Dropped eye lid 22 (9.3%) 7 (11.1%) 0.655 Blepharitis 92 (38.8%) 19 (30.2%) Laceration and chemosis 17 (7.2%) 5 (7.9%) Normal 106 (44.7%) 32 (50.8%) Dry eye Dryness 149 (62.9%) 37 (58.7%) 0.547 Normal 88 (37.1%) 26 (41.3%) Conjunctiva Conjunctival injection 78 (32.9%) 21(33.3%) 0.310 MPC 62 (26.2% 14 (22.2%) Follicular conjunctivitis 45 (19.0%) 9 (14.3%) Trachoma 42 (17.7%) 18 (28.6%) Normal 10 (4.2%) 1 (1.6%) Cornea Keratitis and corneal ulcer 130 (54.9%) 33 (52.4%) 0.726 Normal 107(45.1%) 30 (47.6%) Pupil Dilated 100 (42.2%0 23 (36.5%) 0.256 Constricted 43 (18.1%) 8 (12.7%) Normal 94 (39.7% 32 (50.8%) IOP Hypotony 32 (13.5%) 8 (12.7%) 0.868 Normal 205 (86.5%) 55 (87.3%) Fundus ARMD 57 (24.1%) 19 (30.2%) 0.497 Optic neuropathy 53 (22.4%) 11 (17.5%) Retinal detachment 12 (5.1%) 1 (1.6%) Rvo 17 (7.2% 3 (4.8%) Normal 98 (41.4%) 29 (46.0%) Data are presented as frequency (%). MPC: Marginal Pupil Conjunctivitis, IOP: Intraocular pressure, ARMD: Age-Related Macular Degeneration, Rvo: Retinal Vein Occlusion. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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1","display":"","copyAsset":false,"role":"figure","size":348408,"visible":true,"origin":"","legend":"\u003cp\u003e(A): shows a Schirmer's test being performed on a closed eye show sever dryness, (B): shows a severe case of conjunctival congestion, (C): shows a case of blepharitis, characterized by crusting and scaling along the base of the eyelashes and eyelid margin inflammation, (D): shows the eyes of a patient with ptosis, or drooping of the upper eyelids in alcoholic abuser, (E): shows the everted upper eyelid displaying severe papillary hypertrophy on the tarsal conjunctiva, a key sign of Trachomatous Inflammation, (F): Shows dilated pupil in methamphetamine abuser, (G): shows constricted pupil in opioid abuser, (H): shows a fluorescein stain image of the cornea under cobalt blue light, revealing a large, irregular-shaped epithelial defect or ulcer that has absorbed the stain and appears bright green. This indicates a significant loss of the corneal surface cells, (I): show significant, advanced visual field loss, particularly in the superior field.\u003c/p\u003e","description":"","filename":"Figure1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7612481/v1/40b1b323f363b54e17c052ce.jpeg"},{"id":93291714,"identity":"09012bf3-0ba6-4145-b162-ff946d90ec04","added_by":"auto","created_at":"2025-10-11 09:04:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2299470,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7612481/v1/0df9a3fc-33fb-4e0d-8ab9-720c9e3d1f61.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Addiction and Eye Health","fulltext":[{"header":"Background","content":"\u003cp\u003eThe eye is a fluid-filled, spherical organ composed of three tissue layers\u0026nbsp;\u0026nbsp;\u003csup\u003e[1]\u003c/sup\u003e.The neurons of the neural retina translate the visual information into nerve impulses, which travel through the optic nerve to the brain. The photoreceptors, the bipolar cells and the ganglion cells form a direct pathway to the brain [2].\u0026nbsp;Substance use disorder (SUD) is described in DSM-5 under \u0026quot;Substance-related and addictive disorders,\u0026quot; replacing the outdated term \u0026quot;abuse\u0026quot; found in DSM-III-R. It includes both substance use and substance/medication-induced mental disorders\u0026nbsp;[3].\u003c/p\u003e\n\u003cp\u003eThe rise in SUDs has led to an increased interest in studying their systemic complications. The ocular manifestations often remain under-recognized. The eyes, being highly vascular and neurologically rich structures, are particularly vulnerable to the toxic effects of various substances, both licit and illicit [4]. Substances such as opioids, methamphetamine (Meth), alcohol, cannabis, and others have been reported to cause a wide range of ocular issues\u0026mdash;from mild symptoms like dryness and conjunctival injection to severe complications such as optic neuropathy, retinal detachment, or irreversible vision loss [5].\u003c/p\u003e\n\u003cp\u003eDiplopia may result from alcohol, phencyclidine, barbiturates, or heroin use. Phencyclidine and cocaine can cause corneal anaesthesia and keratitis, while alcohol and nicotine are linked to dry eye. Mydriasis is often induced by cocaine, methamphetamine, LSD, or marijuana, whereas heroin causes miosis. Barbiturates are associated with hippus or an indistinct pupillary response. Nicotine use has been implicated in non-arteritic optic neuropathy, thyroid orbitopathy, and raised intraocular pressure, and both alcohol and nicotine contribute to age-related macular degeneration. Cocaine, methamphetamine, and opioids may lead to retinal venous occlusion and intraretinal haemorrhage, and methamphetamine and heroin are associated with talc retinopathy. Toxic optic neuropathy has been reported with nicotine and methanol, while phencyclidine, barbiturates, and morphine may cause nystagmus. Impaired oculomotor function has been observed with cannabinoid use, palinopsia with LSD, and decreased intraocular pressure with cannabinoids [6].\u003c/p\u003e\n\u003cp\u003eThese effects may result from direct toxic damage, vascular compromise, immune-mediated mechanisms, or secondary to systemic effects of the substances. The degree and type of ocular involvement may also vary depending on the duration, frequency, and combination of substance use [7]. The clinical studies examining these associations, particularly in the Egyptian population, are limited. Most available literature focuses on isolated case reports or specific substances, leaving a significant gap in understanding the broader patterns of ocular pathology related to addiction [8].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe aim of this work\u003c/strong\u003e was to assess ocular side effects due to substance use at El Abassya Mental Health Hospital and the Psychiatry Department at Al-Zahraa University Hospital.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis cross-sectional analytical study was conducted on 300 patients recruited from the Ophthalmology Department, El Abbasiya Mental Health Hospital, and the Psychiatry Department, Al-Zahraa University Hospital, between December 2023 and June 2024. Written informed consent was obtained from all participants. The study was approved by the Ethics Committee of the Faculty of Medicine, El Abbasiya Mental Health Hospital, and Al-Zahraa University Hospital.\u003c/p\u003e\n\u003cp\u003eInclusion criteria were history of substance use, both male and female participants, age between 18 and 50 years and absence of intoxication or withdrawal symptoms for at least four weeks prior to enrolment.\u003c/p\u003e\n\u003cp\u003eExclusion criteria were general systemic comorbidities (e.g., diabetes mellitus, hypertension) and previous history of ocular pathology or ocular surgery.\u003c/p\u003e\n\u003cp\u003eData collection included a detailed history including sociodemographic data including substance use history: onset, duration, type, frequency, history of intoxication, withdrawal episodes, and attempts to quit, types of substances used: cigarettes/shisha, hashish, methamphetamine, alcohol, opioids, gabapentin, and cough medications, medical history and family history including relevant medical or psychiatric conditions, including substance use patterns.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical diagnosis\u003c/strong\u003e of addiction was established according to DSM-5 criteria by senior staff [9].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAddiction severity index (ASI):\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ASI, a semi-structured interview assessing multiple domains (medical, psychiatric, family, legal, social, and drug use), was used to determine the relationship between substance use severity and ocular pathology [10].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOphthalmic examination\u003c/strong\u003e \u003cstrong\u003eincluded:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVisual acuity assessment using Landolt\u0026rsquo;s chart, ocular motility examination, slit-lamp examination of the eyelid, conjunctiva, and anterior segment (cornea, anterior chamber, iris, lens), pupil examination, intraocular pressure measurement using Goldmann applanation tonometry, fundus examination using a +90 D lens (slit-lamp biomicroscopy) and indirect ophthalmoscopy and additional investigations: visual field testing and optical coherence tomography (OCT).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 1\u003c/strong\u003e shows the examination and the follow-up of a case with conjunctival congestion, sever dryness, which showed significant, advanced visual field loss, particularly in the superior field.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analysis was done by SPSS v26 (IBM Inc., Armonk,NY,USA). Quantitative variables were presented as mean and standard deviation (SD) . Qualitative variables were presented as frequency and percentage (%). Qualitative variables were presented as frequency and percentage (%) and were analysed utilizing the Chi-square test. A two tailed P value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean age was 32.96 \u0026plusmn;8.08. The mean duration of substance use by years was 7.14 \u0026plusmn; 3.65. the most common sex was male 212 (70.7%). Working was the occupation of the study participants 241 (80.33%). The most marital status was married155 (51.7%). The most residence was rural 152 (50.7%). Methamphetamine was the most type of substance use (19%). The most frequency of use of Alcohol is twice daily by 12 patients (44.4%). Among nicotine users, 12 patients (48.0%) used it once daily. The most frequency of poly substance use is Twice daily by 22 patients (39.3%). The most frequency of use of Gabapentin is Twice daily by 8 patients (50.0%). The most frequency of use of Opioid is once daily by 22 patients (40.0%). \u0026nbsp;The most frequency of use of Hashish is once or twice daily by 18 patients (36.7%). The most frequency of use of Methamphetamine is twice daily by 22 patients (38.6%). The most frequency of cough medication is twice daily by 8 patients (53.3%)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e. \u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e shows addiction severity index of the studied participants.\u003c/p\u003e\n\u003cp\u003eRegarding ASI, mild complications were reported in 35 patients (11.67%) in the medical domain, in 107 patients (35.67%) in the psychiatric domain, in 96 patients (32%) in the family domain, in 86 patients (28.67%) in the legal domain, in 44 patients (14.67%) in the social domain and in 141 patients (47%) in the dug domain. Table 3\u003c/p\u003e\n\u003cp\u003eDespite the variations in symptoms across the different frequency groups, the differences in ocular manifestations covering vision, eyelid involvement, dry eye symptoms, conjunctival inflammation, corneal pathology, pupil abnormalities, fundus findings, and IOP status\u0026mdash;were not statistically significant (P \u0026gt; 0.05).\u0026nbsp;\u003cstrong\u003eTable\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcross most ophthalmological abnormalities, differences between short-term (\u0026lt;1 year) and long-term (\u0026ge;1 year) substance users were modest, with no statistically significant differences.\u0026nbsp;\u003cstrong\u003eTable 5\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAddiction and substance abuse are major worldwide public health issues that have an impact on almost all bodily organ systems, including the eyes. Because they are extremely vascular and neurologically complex organs, the eyes are especially susceptible to the harmful effects of many substances, both licit and illicit\u0026nbsp;[11]. Misusing certain substances can have serious adverse effects on the eyes\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eranging from dilated pupils related to alcohol consumption to vision loss, which may be associated with intravenous drug misuse.\u003csup\u003e\u0026nbsp;\u003c/sup\u003eThus, the type and severity of the ocular manifestations brought on by substance use depend on the substance, the method of use, and individual health factors [12].\u003c/p\u003e\n\u003cp\u003eDemographic factors play a foundational role in shaping patterns of substance use and addiction across different populations. Age, gender, socioeconomic status, education, employment, and geographic location all interact with an individual\u0026apos;s risk for initiating and maintaining substance use. Young adults, particularly those between the ages of 18 and 35, represent a consistently high-risk group for the onset of substance use. In the current study, participants ranged in age from 20 to 50 years, with a mean \u0026plusmn; standard deviation of 32.96 \u0026plusmn; 8.08 years.\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eThis period of life is often marked by exploration, identity formation, peer influence, and stress related to academic, occupational, or financial challenges\u0026mdash;all of which can increase susceptibility to experimenting with or regularly using addictive substances [13].\u003c/p\u003e\n\u003cp\u003eIn the current study, the mean duration of substance use was 7.14 \u0026plusmn; 3.65 years. This is in line with the findings of Poudel and Gautam\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[14], who reported a median duration of 27 years from first to last use and a median of 9 years from first treatment to last use, underscoring the chronic and prolonged nature of substance use in many individuals. According to our results, the substances of abuse, arranged from most to least common, were: methamphetamine (19%), poly-substance use (18.7%), opioids (18.3%), hashish (16.3%), alcohol (9%), nicotine (8.3%), gabapentin (5.3%), and cough medication (5%). According to Elrassas et al. [15], qualitative urine drug screening revealed that the most commonly detected substance was cannabinoids (53%), followed by synthetic cannabinoids (22%) and Meth (19%). In terms of self-reported substance use, cannabinoids were again the most prevalent (96%), followed by alcohol (38%) and synthetic cannabinoids (33%).\u0026nbsp;Negm and Fouad\u0026nbsp;[16]\u0026nbsp;identified tramadol, cannabis, and alcohol as the most prevalent substances among adolescent school students in Zagazig.\u0026nbsp;\u0026nbsp;. In terms of demographics, 70.7% of participants in the present study were male (n = 212), while 29.3% were female (n = 88). Regarding employment status, 241 participants (80.33%) were employed, whereas 59 (19.67%) were unemployed. Marital status showed that 109 participants (36.3%) were single, 36 (12.0%) were divorced, and 155 (51.7%) were married. The study population was almost evenly divided between urban (n = 148, 49.3%) and rural (n = 152, 50.7%) residents. These findings align with those reported by Lev-Ran et al.\u0026nbsp;[17]\u0026nbsp;who examined demographic differences in the prevalence of substance use disorders (SUDs) among individuals with lifetime exposure to various substances.Gender disparities in substance use behaviors are well-documented, with men consistently reporting higher rates of alcohol, tobacco, and illicit drug use. These differences have been shaped historically by sociocultural norms, peer influences, and gender-specific expectations, which have often rendered substance use more socially acceptable\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eor even encouraged\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eamong males. Biological and psychological factors also play a role, including variations in drug metabolism, levels of impulsivity, and coping strategies.\u0026nbsp;In addition \u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eFemale addicts in Egypt tend to use drugs in secrecy, as this conflicts with cultural traditions and societal morals. Nevertheless, the rate of addiction among girls and women is on the rise.\u003c/p\u003e\n\u003cp\u003eAccording to the ASI, findings across multiple domains revealed varying levels of complications among patients. In the medical domain, mild complications were reported in 35 patients (11.67%), moderate issues in 28 (9.33%), and severe medical conditions in 15 (5%).\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eThese findings are partially consistent with those of\u0026nbsp;Abouzed\u0026nbsp;et al.\u0026nbsp;[18]\u0026nbsp;who reported that, according to the Addiction Severity Index, most cases demonstrated severe drug and alcohol use, along with severe psychiatric, social, medical, and legal problems related to substance dependence.\u0026nbsp;The relatively lower detection of medical complications may be attributed to the index\u0026apos;s focus on chronic health conditions (such as diabetes mellitus and hypertension)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOcular manifestations:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnderstanding the larger patterns of ocular pathology linked to addiction is severely lacking because the majority of the research currently in publication concentrates on individual case reports or particular substances. It is clinically and socially critical to close this gap since vision loss affects both functional independence and quality of \u0026nbsp;life [8]\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eOpioids, Meths, alcohol, cannabis, and other substances have been linked to a variety of eye problems, ranging from minor symptoms like dry eyes and conjunctival injection to serious consequences like optic neuropathy, retinal detachment, or permanent blindness. These consequences could be secondary to the drugs\u0026apos; systemic effects, immune-mediated processes, vascular impairment, or direct toxic harm. The length, frequency, and combination of substance use may also affect the type and degree of ocular involvement\u0026nbsp;[19].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOphthalmological findings:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAlthough there is growing evidence of the consequences of substance use on the eyes, there are few thorough clinical investigations looking at these relationships, especially in the Egyptian population. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVision:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the patients revealed a range of visual and eye-related complications. Regarding visual disturbances, hallucinations were reported in 87 patients (29.0%), disturbed vision in 64 patients (21.3%), loss of vision in 47 patients (15.7%), and diplopia (double vision) in 44 patients (14.7%). In the present study, alcohol, nicotine, polysubstance use, Meth, and hashish were significantly more associated with visual abnormalities compared to opioids, gabapentin, and cough medications (P \u0026lt; 0.001). In Egypt, this trend is considered a significant public health risk, as the prevalence of methamphetamine,alochol and cannabis use is increasing among youth and drivers, contributing to a rise in road traffic accidents.\u003c/p\u003e\n\u003cp\u003eThe underlying pathophysiology typically involves overstimulation or dysregulation of key neurotransmitter systems\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003enamely dopamine, serotonin, and glutamate\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003ewithin the brain\u0026rsquo;s visual processing centers. For example, stimulants such as Meth may induce hyperdopaminergic states, leading to psychosis-like symptoms, whereas substances like cannabis and alcohol are known to distort visual perception by disrupting cortical activity and impairing visual integration [20].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEyelid and anterior segment:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn our study, a wide range of ocular complications were observed among substance users. Eyelid abnormalities included ptosis (drooping eyelid) in 29 patients (9.7%), blepharitis in 111 (37.0%), and laceration with chemosis in 22 (7.3%). Ocular dryness was the most frequently reported symptom, affecting 186 patients (62.0%). Pupillary abnormalities were also common, with pupil dilation observed in 123 patients (41.0%) and constriction in 51 patients (17.0%). Conjunctival involvement included conjunctival injection in 99 patients (33.0%), mucopurulent conjunctivitis (MPC) in 76 (25.3%), follicular conjunctivitis in 54 (18.0%), and trachoma-like findings in 60 patients (20.0%). Corneal complications were reported in 163 patients (54.3%), primarily in the form of keratitis and corneal ulcers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubstance-specific associations:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analysis revealed several substance-specific associations: Eyelid abnormalities were significantly more prevalent among users of alcohol, methamphetamine, cough medications, and poly-substances compared to those using opioids, gabapentin, hashish, and nicotine (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). Ocular dryness was significantly more common in individuals using nicotine, cough medications, and poly-substances than in those using alcohol, opioids, gabapentin, hashish, or methamphetamine (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). Keratitis and corneal ulcers were more frequently associated with alcohol, nicotine, and opioid use than with other substances (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). Pupil dilation was significantly more prevalent in users of cough medications and methamphetamine, while pupil constriction was predominantly seen in opioid users (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). Conjunctival changes (e.g., injection, MPC, and trachoma-like features) were significantly higher among users of alcohol, methamphetamine, cough medications, and poly-substances (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003eStructural and functional changes in the anterior segment of the eye\u0026mdash;such as ptosis, dryness, and conjunctival inflammation\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003ewere particularly pronounced among users of certain substances. Drooping eyelids were notably associated with alcohol, Meth, cough mixtures, and poly-substance use, likely reflecting both neuromuscular and dermatologic involvement [21].\u003c/p\u003e\n\u003cp\u003eA meta-analysis by Xu et al.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[22] further supports this association, demonstrating that tobacco smoking significantly increases the risk of dry eye due to impaired tear production and glandular dysfunction. Conjunctival inflammation, including injection and MPC, was frequently observed among users of stimulants and alcohol. This aligns with a case report by Isaak and Liesegang [23], which described severe conjunctival and episcleral redness in a stimulant-injecting patient. The mechanisms likely include direct irritation from toxic substances, poor hygiene, immune dysregulation, and exposure to environmental pathogens [24, 25]. \u0026nbsp;These results align with a retrospective cohort study by Lopez et al. [26], revealed more severe presentations, including larger ulcers, poorer baseline visual acuity, and worse final outcomes compared to non-users.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePosterior segment findings and intraocular pressure abnormalities:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn our study, posterior segment complications were significantly more common among individuals using alcohol, poly-substances, cough medications, and Meth than those using opioids, gabapentin, hashish, or nicotine (P \u0026lt; 0.001). Specific fundus pathologies included ARMD in 76 patients (25.3%), optic neuropathy in 64 (21.3%), retinal detachment in 13 (4.3%), and RVO in 20 (6.7%).\u0026nbsp;These posterior segment disorders are likely multifactorial in origin, involving toxic optic nerve injury, retinal ischemia, and oxidative stress. Methamphetamine has been specifically associated with retinal vascular compromise and ischemia, while chronic alcohol intake is a known risk factor for nutritional optic neuropathy\u0026nbsp;[27].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntraocular pressure (IOP) and pupillary changes:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSignificant alterations in intraocular pressure (IOP) and pupillary responses were also documented: Hypotony was more frequently observed in hashish users compared to other substance groups (\u003cem\u003eP\u003c/em\u003e = 0.001), potentially reflecting cannabinoid-induced suppression of aqueous humor production. Pupil dilation was significantly more common among methamphetamine and cough medication users, consistent with the sympathomimetic effects of stimulants and decongestants. In contrast, pupil constriction was predominantly seen in the opioid group, aligning with the well-known miotic effects of opioids (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003eThese findings underscore the \u003cstrong\u003ediverse ocular effects\u003c/strong\u003e of different substances and the importance of considering both systemic and local mechanisms of ocular involvement\u0026nbsp;[28].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOphthalmological finding caused by substance use:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVision included Hallucinations with Alcohol (59.3%), disturbed vision with Nicotine (80%), loss of vision with Opioid (27.3%) and Diplopia with cough medication (80%). Eyelid included Dropped eyelid with Alcohol (63.0%), Blepharitis with cough medication (66.7%) and laceration \u0026amp; chemosis with Hashish (12.2%). Dry eye included Dryness with Nicotine (96%). Conjunctiva included conjunctival injection with Hashish (51.0%), MPC with cough medication (46.7%), follicular conjunctivitis with Nicotine (20%) and trachoma in poly substance use (28.6%). Cornea included Keratitis \u0026amp; corneal ulcer with Alcohol (70.4%). Pupil included dilated with Methamphetamine (89.5%) and constricted in opioid (72.7%). Intraocular pressure (IOP) included Hypotony with Hashish (81.6%). \u0026nbsp; Fundus included ARMD with Nicotine (84%), optic neuropathy with Opioid (45.5%), retinal detachment with Alcohol (7.4%) and retinal vein occlusion (RVO) with Opioid (20.0%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study demonstrates that substance use is associated with a wide spectrum of ophthalmological abnormalities, many of which can significantly impair vision and overall quality of life. Nicotine, alcohol, opioids, methamphetamine, hashish, and cough medications each showed a dominant association with specific, often severe, eye conditions. Notably, nicotine use was strongly linked to high rates of ocular surface dryness (96%) and age-related macular degeneration (84%), indicating a substantial long-term threat to vision. Alcohol use showed the highest association with visual hallucinations and corneal disease, while opioids were most strongly linked to optic neuropathy and pupil constriction, both of which can result in irreversible vision loss. Methamphetamine use was associated with a markedly high prevalence of pupillary dilation (89.5%), and hashish use was strongly related to ocular hypotony (81.6%), a potentially vision-threatening condition\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eThese findings highlight that substance use not only poses serious risks to general health but also exerts profound and varied adverse effects on ocular health, underlining the need for early detection, targeted prevention, and multidisciplinary management strategies. Smoking has been associated with a variety of ocular surface disturbances. These include alterations in the conjunctival flora, ocular irritation, conjunctival redness, dry eye symptoms, ocular surface inflammation, and meibomian gland dysfunction [29]. One of the most consistent findings is a reduction in tear film breakup time, indicating tear film instability. While Schirmer\u0026rsquo;s test results may vary\u0026mdash;being normal, decreased, or paradoxically elevated\u0026mdash;this variation often reflects reflex tearing in response to surface irritation rather than adequate baseline tear production [30].\u003c/p\u003e\n\u003cp\u003eRegarding the daily frequency\u0026nbsp;of substance use, 44.4% of alcohol users reported consuming alcohol twice daily).\u0026nbsp;Increased alcohol consumption and its negative effects on the eyes, depending on its duration in the bloodstream, and frequencz of use will lead to many disasters and accidents, which will in turn affect the health of the community. Among nicotine users, 12 patients (48.0%) used it once daily. For poly-substance users, 22 patients (39.3%) reported twice-daily use, while 18 patients (32.1%) used substances three times daily. Among gabapentin users, 5 patients (31.3%) reported once-daily use and 8 (50.0%) used it twice daily. Opioid users reported varying frequencies, with 22 patients (40.0%) using once daily and 17 (30.9%) using three times per day. Hashish use was distributed as follows: 18 patients (36.7%) used it once or twice daily, and 13 patients (26.5%) used it three times per day. Methamphetamine was used twice daily by 22 patients (38.6%) and three times daily by 18 (31.6%). Among cough medication users, 8 patients (53.3%) reported twice-daily use. Overall, the frequency of daily substance use did not differ significantly across the various substance groups in the studied sample (P \u0026gt; 0.05). \u0026nbsp;Despite the variations in reported symptoms across the different frequency groups, the differences in ocular manifestations covering vision, eyelid involvement, dry eye symptoms, conjunctival inflammation, corneal pathology, pupil abnormalities, fundus findings, and IOP status\u0026mdash;were not statistically significant (P \u0026gt; 0.05). Vision, eye lid, Dry eye, conjunctiva, cornea, pupil, fundus and IOP were insignificantly different between both groups. The findings reveal a clear trend: higher daily frequency of substance use is generally associated with increased prevalence of several ophthalmological abnormalities, notably hallucinations, ocular surface dryness, conjunctival injection, keratitis, pupil dilation, and ARMD. Although some conditions, such as loss of vision and hypotony, appeared with similar frequency across use patterns, others showed a dose\u0026ndash;response relationship, suggesting cumulative toxic effects on ocular tissues. These results emphasize that not only the type of substance but also the frequency of use significantly influences eye health, compounding the overall burden on both visual function and general health.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOphthalmological findings by duration of substance use:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcross most ophthalmological abnormalities, differences between short-term (\u0026lt;1 year) and long-term (\u0026ge;1 year) substance users were modest, with no statistically significant differences. However, certain trends were noted: long-term users showed higher rates of trachoma and ARMD, indicating cumulative ocular damage over time, while short-term users had slightly higher rates of hallucinations, blepharitis, and pupil dilation, possibly reflecting acute or early toxic effects. These findings suggest that substance use, regardless of duration, poses substantial risks to ocular health, but prolonged exposure may contribute more to chronic structural eye disease, adding to the long-term burden on vision and general health.\u003c/p\u003e\n\u003cp\u003eAlcohol intake in short term leads to dilated pupils, slower pupillary reaction, diplopia, night vision disturbances decreased contrast sensitivity, congested eyes, twitching of eyelid (myokymia) due to excessive intake and nystagmus. Alcohol intake may impair the vision or orientation to visuospatial stimuli due to the various mechanisms. Alcohol intoxication can also impair mesopic rod and cone temporal processing pathways. Chronic intake of alcohol can cause external ophthalmoplegia (due to thiamine deficiency), toxic amblyopia and ARMD [31]. Cigarette smoking is one of the most common and the most alarming health problem today. It can affect multiple structures in the body as well as the eye due to chemical toxicity and free radical-related oxidative damage. Nicotine has been reported to cause alteration of the conjunctival flora, irritation, redness, dry eye, ocular surface inflammation and meibomian gland dysfunction.With chronic use , Smoking \u0026nbsp;increases the risk of squamous metaplasia of bulbar conjunctiva and conjunctival intraepithelial neoplasia. Corneal wound healing is delayed in smokers, increasing the risk of keratitis and poor healing of epithelial defect or ulcer [32].\u003c/p\u003e\n\u003cp\u003eOpioid use can also significantly affect ocular health, most notably causing miosis (pinpoint pupils), a classic sign of opioid intoxication resulting from parasympathetic stimulation. This pupil constriction can impair vision in low-light environments and may contribute to visual discomfort or blurred vision. Chronic opioid use has been linked to reduced tear production and dry eye symptoms, possibly due to suppression of parasympathetic activity affecting lacrimal gland function. \u0026nbsp;Garc\u0026iacute;a- Garc\u0026iacute;a-L\u0026oacute;pez et al. [33] noted that chronic opioid users reported a significantly higher incidence of dry eye complaints and visual disturbances, suggesting both neurological and ocular surface involvement. Cannabis intake leads to conjunctival injection, dilated pupils, reduced accommodation amplitude and impaired oculomotor function in chronic users. Impaired oculomotor function can manifest in the form of increase in latency to initiate saccades, impairment in processing of saccades and impaired visuospatial working memory.\u003c/p\u003e\n\u003cp\u003eThe limitations of the study were that the relatively small sample size may be contributed to some insignificant results.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe use of alcohol, methamphetamine, and cannabis among youth represents a substantial public health concern, given the combined neurological, behavioral, and ocular risks associated with these substances. Alcohol impairs visual function, coordination, and cognitive processing, thereby increasing accident risk, while chronic use can result in optic neuropathy. Methamphetamine is associated with severe neurotoxicity, psychiatric complications, and significant ocular effects, including mydriasis, keratitis, and retinal injury. Cannabis use during youth disrupts neurodevelopment, impairs attention and visual perception, and may exacerbate ocular conditions such as conjunctival injection and increased intraocular pressure. Early initiation of these substances heightens the likelihood of dependency, long-term visual impairment, and reduced quality of life, underscoring the urgent need for targeted prevention strategies and ocular health awareness programs in young populations. With further studies to investigate the short- and long-term effects of specific substances on ocular structures. Substance use is significantly associated with a wide range of ocular complications, with specific substances causing distinct patterns of eye involvement.\u003c/p\u003e\u003cp\u003eTherefore, we recommend conducting further studies to investigate the short- and long-term effects of specific substances on ocular structures. Additionally, public health awareness should be increased regarding the ocular complications of substance use and its impact on quality of life.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe use of alcohol, methamphetamine, and cannabis among youth represents a substantial public health concern, given the combined neurological, behavioral, and ocular risks associated with these substances. Alcohol impairs visual function, coordination, and cognitive processing, thereby increasing accident risk, while chronic use can result in optic neuropathy. Methamphetamine is associated with severe neurotoxicity, psychiatric complications, and significant ocular effects, including mydriasis, keratitis, and retinal injury. Cannabis use during \u0026nbsp;youth disrupts neurodevelopment, impairs attention and visual perception, and may exacerbate ocular conditions such as conjunctival injection and increased intraocular pressure. Early initiation of these substances heightens the likelihood of dependency, long-term visual impairment, and reduced quality of life, underscoring the urgent need for targeted prevention strategies and ocular health awareness programs in young populations. With\u0026nbsp;further studies to investigate the short- and long-term effects of specific substances on ocular structures. Substance use is significantly associated with a wide range of ocular complications, with specific substances causing distinct patterns of eye involvement.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTherefore, we recommend conducting further studies to investigate the short- and long-term effects of specific substances on ocular structures. Additionally, public health awareness should be increased regarding the ocular complications of substance use and its impact on quality of life.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eASI: Addiction Severity Index, SUD: Substance use disorder, OCT :Optical coherence tomography, SD :standard deviation , MPC :Marginal Pupil Conjunctivitis, IOP :Intraocular pressure, ARMD :Age-Related Macular Degeneration , Rvo: Retinal Vein Occlusion, MPC: Marginal Pupil Conjunctivitis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e The study was approved by the Ethics Committee of the Faculty of Medicine, El Abbasiya Mental Health Hospital, and Al-Zahraa University Hospital .Written informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Written informed consent was obtained from all participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e Availability of data and material: The data supporting the present findings are contained within the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The authors declare that no funds, grants, or other support were received for the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: A.H.R. \u0026amp;Y.M.E.M., methodology: Y.M.E.M. \u0026amp; R.M.I., Formal analysis and investigation: A.H.R.\u0026amp;R.M.I., Writing\u0026mdash;original draft preparation: Y.M.E.M., Writing\u0026mdash;review and editing: O.I.A., R.M.I., supervision, validation and final editing: Y.M.E.M.,A.H.R.\u0026amp; R.M.I., all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAgrahari V, Mandal A, Agrahari V, Trinh HM, Joseph M, Ray A, et al. (2016) A comprehensive insight on ocular pharmacokinetics. Drug Deliv Transl Res.6:735-54.https://doi.org/10.1007/s13346-016-0339-2\u003c/li\u003e\n\u003cli\u003eZouache MA (2022) Variability in Retinal Neuron Populations and Associated Variations in Mass Transport Systems of the Retina in Health and Aging. Front Aging Neurosci.14:778404.https://doi.org/10.3389/fnagi.2022.778404\u003c/li\u003e\n\u003cli\u003eSaladino V, Mosca O, Petruccelli F, Hoelzlhammer L, Lauriola M, Verrastro V, et al. (2021) The Vicious Cycle: Problematic Family Relations, Substance Abuse, and Crime in Adolescence: A Narrative Review. 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(2022) Opioids and ocular surface pathology: a literature review of new treatments horizons. J Clin Med.11:14-24\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1: Demographic characteristics, types of substances used, and frequency of use among the study participants (N = 300)\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"103%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItems\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(n=300)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"9\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographic data\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"8\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 23px;\"\u003e\n \u003cp\u003e32.96 \u0026plusmn;8.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of substance use by years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 23px;\"\u003e\n \u003cp\u003e7.14 \u0026plusmn; 3.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" rowspan=\"2\" style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 23px;\"\u003e\n \u003cp\u003e212 (70.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 23px;\"\u003e\n \u003cp\u003e88 (29.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" rowspan=\"2\" style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWorking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 23px;\"\u003e\n \u003cp\u003e241 (80.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot working\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 23px;\"\u003e\n \u003cp\u003e59 (19.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" rowspan=\"3\" style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSingle\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 23px;\"\u003e\n \u003cp\u003e109 (36.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDivorced\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 23px;\"\u003e\n \u003cp\u003e36 (12.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarried\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 23px;\"\u003e\n \u003cp\u003e155 (51.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" rowspan=\"2\" style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUrban\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 23px;\"\u003e\n \u003cp\u003e148 (49.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRural\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 23px;\"\u003e\n \u003cp\u003e152 (50.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"12\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of substance use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 27)\u003c/strong\u003e \u003cstrong\u003e(9%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNicotine\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 25)\u003c/strong\u003e \u003cstrong\u003e(8.33%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePoly substance use (n= 56)\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(18.67%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGabapentin\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 16)\u003c/strong\u003e\u0026nbsp; \u003cstrong\u003e(5.33%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpioid\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 55)\u003c/strong\u003e \u003cstrong\u003e(18.33%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHashish\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 49)\u003c/strong\u003e \u003cstrong\u003e(16.33%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMethamphetamine\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 57)\u003c/strong\u003e \u003cstrong\u003e(19%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCough medication\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 15)\u003c/strong\u003e \u003cstrong\u003e(5%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of use / day\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOnce\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e8 (29.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e12 (48.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e16 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e5 (31.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e40.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e18 (36.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e17 (29.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e4 (26.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTwice\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e12 (44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e5 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e22 (39.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e8 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e16 (29.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e18 (36.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e22 (38.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e8 (53.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTriple\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e7 (25.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e8 (32.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e18 (32.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e3 (18.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e17 (30.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e13 (26.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e18 (31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e3 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"12\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as mean \u0026plusmn; SD or frequency (%). MPC: Marginal Pupil Conjunctivitis, IOP: Intraocular pressure, ARMD: Age-Related Macular Degeneration, Rvo: Retinal Vein Occlusion.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2: Addiction severity index of the studied participants\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItems\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(n=300)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedical\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e35 (11.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e28 (9.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSever\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e15 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychiatric\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e107 (35.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e47 (15.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSever\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e8 (2.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e96 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e43 (14.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSever\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e12 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLegal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e86 (28.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e31 (10.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSever\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e8 (2.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e44 (14.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e30 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSever\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDrug\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e141 (47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e106 (35.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSever\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e4 (1.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as frequency (%). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;3: Ophthalmological findings among the studied sample according to substance type\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"112%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"10\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of substance use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 27)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNicotine\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 25)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePoly substance use\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 56)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGabapentin\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 16)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpioid\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 55)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHashish\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 49)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMethamphetamine\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 57)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCough medication\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 15)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVision\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHallucinations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e16 (59.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e31 (55.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e20 (40.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e20 (35.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisturbed vision\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2 (7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e20 (80.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e7(12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e20 (36.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e5 (10.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e10 (17.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLoss of vision\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e4 (14.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e6 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e15 (27.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e7 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e15 (26.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiplopia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e5 (18.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e11 (19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e11 (68.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e3 (6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e12 (80.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e5 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e531.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e20 (36.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e14 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e10 (17.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e3 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"10\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEye lid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDropped eye lid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e17 (63.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e12(21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBlepharitis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e7 (25.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e12 (48.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e22 (39.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e6 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e12 (21.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e15 (30.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e27 (47.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e10 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaceration and chemosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e3 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e5 (8.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e5.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e6 (12.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e5 (8.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e52.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e17 (30.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e10 (62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e40 (72.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e28 (57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e25 (43.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e5 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"10\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDry eye\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDryness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e14 (51.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e24 (96.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e40 (71.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e7 (43.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e36 (65.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e29 (59.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e25 (43.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e11 (73.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e13 (48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e16 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e9 (56.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e19 (34.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e20 (40.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e32 (56.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e4 (26.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"10\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConjunctiva\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConjunctival injection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e12 (44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e13 (52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e12 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e20 (36.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e25 (51.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e17 (29.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMPC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e5 (18.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e5 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e13 (23.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e6 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e10 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e10 (20.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e20 (35.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e7 (46.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollicular conjunctivitis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e6 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e20.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e15 (26.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e5 (31.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e6 (10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e5 (10.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e7 (12.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e5 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTrachoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e4 (14.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e16 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e5 (31.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e10 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e9 (18.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e11 (19.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e3 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"10\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCornea\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKeratitis and corneal ulcer\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e19 (70.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e20 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e35 (62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e10 (62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e37 (67.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e15 (30.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e17 (29.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e10 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e8 (29.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e5 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e21 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e6 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e18 (32.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e34 (69.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e40 (70.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e5 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"10\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePupil\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDilated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e17 (63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e12 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e30 (61.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e51 (89.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e13 (86.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConstricted\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e11 (19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e40 (72.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e10 (37.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e25 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e33 (58.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e16 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e15 (27.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e19 (38.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e6 (10.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e2 (13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"10\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIOP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypotony\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e40 (81.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e27 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e25 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e56 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e16 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e55 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e9 (18.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e57 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e15 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"10\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFundus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eARMD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e10 (37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e21 (84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e15 (26.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e7 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e9 (18.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e6 (10.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e8 (53.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOptic neuropathy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e12 (44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e10 (17.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e25 (45.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e10 (20.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e7 (12.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRetinal detachment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2 (7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e3 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e3 (5.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e5 (8.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRvo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e4 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e11 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e5 (8.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e3 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e4 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e24 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e16 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e9 (16.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e30 (61.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e34 (59.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e7 (46.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"10\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as frequency (%), MPC: Marginal Pupil Conjunctivitis, IOP: Intraocular pressure, ARMD: Age-Related Macular Degeneration, Rvo: Retinal Vein Occlusion. * significant as P-value \u0026le; 0.05.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;4: Ophthalmological findings among the sample studied according to frequency of substance uses per day\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItems\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of use per day\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOnce\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=102)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTwice\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=111)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTriple\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=87)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVision\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHallucinations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e19(18.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e37(33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e31(35.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.160\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisturbed vision\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e28(27.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e19(17.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e17(19.5%0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLoss of vision\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e17(16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e17(15.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e13(14.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiplopia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e14(13.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e20(18.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e10(11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e24(23.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e18(16.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e16(18.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEye lid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDropped eye lid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e7 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e10(9.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e12(13.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.119\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBlepharitis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e32(31.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e45(40.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e34(39.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaceration and chemosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e6(5.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e12(10.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e4(4.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e57(55.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e44(39.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e37(42.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDry eye\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDryness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e56(54.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e71(64.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e59(67.8%0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e46(45.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e40(36.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e28(32.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConjunctiva\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConjunctival injection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e24(23.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e38(34.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e37(42.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.119\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMPC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e28(27.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e32(28.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e16(18.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollicular conjunctivitis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e25(24.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e14(12.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e15(17.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTrachoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e21(20.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e24(21.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e15(17.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e4(3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e3(2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e4(4.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCornea\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKeratitis and corneal ulcer\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e50(49.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e61(55.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e52(59.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.330\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e52(51.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e50(45.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e35(40.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePupil\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDilated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e33(32.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e50(45.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e40(46.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConstricted\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e20(19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e17(15.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e14(16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e49(48.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e44(39.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e33(37.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIOP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypotony\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e13(12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e16(14.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e11(12.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e89(87.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e95(85.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e76(87.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFundus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eARMD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e19(18.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e26(23.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e31(35.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOptic neuropathy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e23(22.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e26(23.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e15(17.20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRetinal detachment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e3(2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e6(5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e4(4.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRvo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e9(8.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e4(3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e7(8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e48(47.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e49(44.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e30(34.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as frequency (%). MPC: Marginal Pupil Conjunctivitis, IOP: Intraocular pressure, ARMD: Age-Related Macular Degeneration, Rvo: Retinal Vein Occlusion.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;5: Ophthalmological findings among the sample studied according to duration of substance uses\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of substance uses\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 1 year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;=1 year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVision\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHallucinations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e72 (30.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e15 (23.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.332\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisturbed vision\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e51 (21.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e13 (20.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLoss of vision\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e38 (16.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e9 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiplopia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e36 (15.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e8 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e40 (16.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e18 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEye lid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDropped eye lid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e22 (9.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e7 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.655\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBlepharitis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e92 (38.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e19 (30.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaceration and chemosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e17 (7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e5 (7.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e106 (44.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e32 (50.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDry eye\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDryness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e149 (62.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e37 (58.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.547\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e88 (37.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e26 (41.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConjunctiva\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConjunctival injection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e78 (32.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e21(33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.310\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMPC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e62 (26.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e14 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollicular conjunctivitis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e45 (19.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e9 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTrachoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e42 (17.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e18 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e10 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e1 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCornea\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKeratitis and corneal ulcer\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e130 (54.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e33 (52.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.726\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e107(45.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e30 (47.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePupil\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDilated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e100 (42.2%0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e23 (36.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConstricted\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e43 (18.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e8 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e94 (39.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e32 (50.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIOP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypotony\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e32 (13.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e8 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.868\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e205 (86.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e55 (87.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFundus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eARMD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e57 (24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e19 (30.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.497\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOptic neuropathy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e53 (22.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e11 (17.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRetinal detachment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e12 (5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e1 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRvo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e17 (7.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e3 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e98 (41.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e29 (46.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as frequency (%). MPC: Marginal Pupil Conjunctivitis, IOP: Intraocular pressure, ARMD: Age-Related Macular Degeneration, Rvo: Retinal Vein Occlusion.\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Addiction, Eye Health, Substance","lastPublishedDoi":"10.21203/rs.3.rs-7612481/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7612481/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe growing prevalence of substance use disorders has heightened interest in their systemic complications. This study aimed to evaluate the ocular effects associated with substance use among patients at El Abbasiya Mental Health Hospital and the Psychiatry Department of Al-Zahraa University Hospital.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis cross-sectional analytical study included 300 patients recruited from El Abbasiya Mental Health Hospital (Ophthalmology Department) and Al-Zahraa University Hospital (Psychiatry Department). All participants were diagnosed with addiction according to DSM-5 criteria, assessed using the Addiction Severity Index (ASI), and underwent a comprehensive ophthalmic examination.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eHallucinations were most common among alcohol users, while disturbed vision, dryness, keratitis, and corneal ulceration were most frequently observed in nicotine users. Diplopia was most prevalent among individuals using cough medications. Alcohol, poly-substance use, methamphetamine, and cough medications were associated with higher rates of visual disturbances, conjunctival changes, eyelid dysfunction, and fundus abnormalities. Opioid use was notably linked to a higher prevalence of constricted pupils. Differences in visual impairment across varying frequencies and durations of substance use were not statistically significant. According to the ASI, mild complications were reported in 35 patients (11.67%) in the medical domain and in 107 patients (35.67%) in the psychiatric domain. Despite the high prevalence of substance use, no significant association was found between ophthalmic complications and either the frequency or duration of substance use. This may be attributed to the relatively small and selective sample, as well as the use of a specific questionnaire.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eSubstance use is significantly associated with a broad spectrum of ocular complications, with distinct substances producing characteristic patterns of eye involvement.\u003c/p\u003e","manuscriptTitle":"Addiction and Eye Health","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 18:42:00","doi":"10.21203/rs.3.rs-7612481/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"10ae6d6c-14b5-4678-9891-0f63d63a0ed1","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-11T08:56:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 18:42:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7612481","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7612481","identity":"rs-7612481","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}