Eric Gaier, MD, PhD, and Dean Eliott, MD, of the Department of Ophthalmology at Mass Eye and Ear, a member of the Mass General Brigham healthcare system, are co-authors of a paper published in Ophthalmology Retina, ” Substance Use Disorder Interventions and Ophthalmic Outcomes for Injection Drug Use-Associated Endogenous Endophthalmitis .”
Q: What challenges or unmet needs make this study important?
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. As ophthalmologists, we are often the first specialists involved in caring for these patients, placing vision care at a unique intersection between acute medical illness and long-term health outcomes.
Q: What central question(s) were you investigating?
First, we wanted to determine whether involving addiction consult services in our care of these patients actually changed their access to medications for substance use disorder (specifically, opioid use disorder).
Second, we sought to understand what clinical or substance-related factors are associated with worse visual outcomes, particularly in the current era of increased fentanyl use.
Q: What methods or approach did you use?
We reviewed the clinical course of patients treated for injection drug use–associated endogenous endophthalmitis at Mass General Brigham over a six-year period. We 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.
Q: What did you find?
We 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 five-fold 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.
Q: What are the real-world implications, particularly for patients?
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 healthcare 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.
Q: What part of this research feels most meaningful personally?
What feels most meaningful is demonstrating that ophthalmologists can play an active role in connecting patients to life-saving addiction care. Vision loss may be what brings a patient to the hospital, but addressing the underlying condition, substance use disorder, has the potential to change the trajectory of or save someone’s life.
Mass Eye and Ear is a member of a large health system with addiction medicine and infectious disease services readily available. This ecosystem enables our ophthalmologists to direct patients with challenging, life-threatening or multi-system disease to multidisciplinary care that can be invaluable.
Authorship: In addition to Gaier and Eliott, Mass General Brigham authors include George N. Papaliodis and Eugene Lambert.
Paper cited: Sokol J.T., et al. “Substance Use Disorder Interventions and Ophthalmic Outcomes for Injection Drug Use-Associated Endogenous Endophthalmitis.” Ophthalmology Retina. DOI: 10.1016/j.oret.2026.01.004
Disclosures: None.
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