People who use injection drugs are at a higher risk for eye infections, particularly endogenous endophthalmitis—a medical emergency caused by bacteria or fungi entering the bloodstream to reach the inside of the eye. These individuals may present to eye clinics or emergency rooms with severe, vision?threatening disease. However, the underlying substance use disorder that led to their infection is often not addressed in a systematic way.
These encounters represent a critical—and often missed—opportunity to connect patients with evidence?based, life?saving addiction treatments.
Researchers at the Mass General Brigham health care system examined substance use disorder care and outcomes in these patients. First, they wanted to determine whether involving addiction consultation services in the care of these patients actually changed their access to medications for substance use disorder (specifically, opioid use disorder).
Second, they sought to understand what clinical or substance?related factors are associated with worse visual outcomes, particularly in the current era of increased fentanyl use.
Eric Gaier, MD, Ph.D., and Dean Eliott, MD, of the Department of Ophthalmology at Mass Eye and Ear, are co?authors of a paper published in Ophthalmology Retina, titled “Substance Use Disorder Interventions and Ophthalmic Outcomes for Injection Drug Use?Associated Endogenous Endophthalmitis.”
The researchers reviewed the clinical course of patients treated for injection drug use–associated with endogenous endophthalmitis at Mass General Brigham over a six?year period. They examined both ophthalmic outcomes—such as vision and complications—and addiction?related care, including whether patients were seen by an addiction consult service and whether medications for opioid use disorder were initiated.
They found that medications for opioid use disorder were only initiated when the addiction consult service was involved, and never when it wasn’t. In other words, without formal addiction consultation, eligible patients simply did not receive these life?saving treatments for their substance use.
From an ophthalmic standpoint, most patients experienced improvements in vision, but those who reported fentanyl use had dramatically worse outcomes, with more than fivefold higher odds of severe vision loss. These findings highlight fentanyl as a particularly dangerous factor not only for overdose risk, but also for irreversible visual disability.
This study reinforces that eye doctors can offer much more to patients than vision care alone. For patients with injection drug use–related infections, an ophthalmology visit may be one of the few times they engage with the health care system. Ensuring that addiction consult services are involved through these encounters can directly impact these individuals’ survival, not just their sight.
For patients and families, the message is clear: addressing substance use disorder alongside acute medical problems is essential to preventing both vision loss and life?threatening complications.
More information
Jared T. Sokol et al, Substance Use Disorder Interventions and Ophthalmic Outcomes for Injection Drug Use–Associated Endogenous Endophthalmitis, Ophthalmology Retina (2026). DOI: 10.1016/j.oret.2026.01.004
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