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Various drugs and other substances can affect the appearance of your eyes, and cocaine’s no different.

While there are a number of potential signs of cocaine use, dilated pupils and bloodshot eyes are among them.

You might have even heard the term “cocaine eyes” being used to describe eyes that look dilated or bloodshot.

But it’s worth noting that many things, from air pollution to underlying health conditions, can have a similar effect on someone’s eyes.

Here’s a closer look at how cocaine affects your eyes and what to do if you’re concerned about someone else.

One of coke’s most noticeable effects is pupil dilatation, meaning it makes your pupils appear larger than usual.

Being a stimulant, cocaine can trigger the release of chemicals and endorphins in the brain. This can inhibit the reuptake of the neurotransmitter norepinephrine.

Usually, pupils dilate in response to low light. But they can also dilate as a response to norepinephrine, which, along with adrenaline, is responsible for the fight, flight, or freeze response that happens when you face a threat.

Because cocaine results in more norepinephrine, it can similarly cause your pupils to dilate.

When snorted, cocaine can cause pupil dilation within a few minutes, and this effect can last for about 30 minutes. Smoking freebase cocaine (crack), on the other hand, causes it to happen almost immediately, and can last for up to 7 minutes.

Using cocaine can also make your eyes appear bloodshot and watery. This happens because cocaine causes your blood vessels to constrict, which increases blood pressure.

This not only results in bloodshot eyes, but also increases your chances of experiencing damage to your cornea (more on this in a moment).

Coke-related bloodshot eyes can last anywhere from a few hours to several days after use, depending on a range of factors, including how much you used, whether it contained contaminants, and your overall health.

Aside from bloodshot eyes and dilated pupils, more frequent or long-term use of cocaine can contribute to a range of health conditions that affect your eyes.

Some of these include:

  • Corneal ulcers/injuries. These can happen if you rub your eyes after touching cocaine, or if it passes through your tear duct while snorting. Your eyes might feel scratchy or painful and appear red and irritated.
  • Cycloplegia. Also known as paralysis of the ciliary muscle in your eye, this condition can result from frequent cocaine use. The main symptom is trouble focusing on objects both near and somewhat far away.
  • Exophthalmos. More commonly known as bulging or protruding eyeballs, this condition sometimes happens with long-term cocaine use. Left untreated, it can compress your optic nerve, permanently affecting your eyesight.
  • Upper eyelid retraction. Chronic cocaine use is also linked to retraction of the upper eyelid, which occurs when your eyelid sits too high on your eye. This can result in dryness and irritation in your eyes over time.

While certain eye signs might suggest cocaine use, this isn’t a reliable way to determine whether someone’s using cocaine.

Again, many things can cause redness in the eyes. It could be allergies or even a side effect of an over-the-counter medication.

While dilated pupils are less common, there are plenty of other explanations for them. Maybe they just came from the optometrist, where they had their eyes dilated. Or they’re aroused or excited by something. They might also be taking a prescribed medication that causes dilated pupils.

Even if you’re positive that none of the above apply to the person, it’s best to avoid judging someone by their eyes.

If you don’t know the person well, you may want to reconsider saying anything, even if you’re 100 percent sure they’re using cocaine. Substance use is complex, and people use drugs for a range of reasons.

Plus, there’s a lot of stigma surrounding substance use. Approaching someone you aren’t particularly close with about your concerns might just result in them feeling unnecessary shame. Keep in mind that using cocaine also doesn’t necessarily mean someone’s in immediate danger.

If you’re concerned about someone you are close with, try simply checking in with them. How have they been feeling? What’s going on in their life right now? Are they facing a lot of stress on the job or at home?

By opening up the floor for a conversation, you can give them a chance to bring up any substance use on their terms.

If nothing comes up but you’re concerned they may need help, avoid making any kind of accusation. Instead of saying something like, “I know you’re using cocaine,” try a gentler approach, like, “Hey, I’ve noticed some changes in you recently, is there anything else going on you want to talk about?”

Be prepared to not get the kind of answers you were looking for. Rather than continuing to push the subject, let them know you’re available and ready to lend a listening ear whenever they need it.

Cocaine can affect your eyes in a number of ways, from making them appear bloodshot or dilated to contributing to various eye conditions.

However, these eye effects can all have plenty of other causes, so it’s best to avoid jumping to conclusions if you notice them in someone else.

Adam England is a freelance writer and journalist. His work has appeared in publications including The Guardian, Euronews, and VICE UK. He focuses on health, culture, and lifestyle. When he’s not writing, he’s probably listening to music.