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  1. Lugo, Susanna Iveth Vazquez SN
  2. Parsh, Bridget MSN, EdD, RN, CNS

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A college student was recently admitted to the ED with severe eye pain, which he attributed to the practice of "vodka eyeballing" at a party. I have never heard of this. What can you tell me about it?-M.N., FLA.


Susanna Iveth Vazquez Lugo, SN, and Bridget Parsh, MSN, EdD, RN, CNS, reply: Although alcohol is typically consumed as a beverage, social media is driving the rapid spread of new routes for alcohol ingestion. One of these, commonly termed "eyeballing" or "vodka eyeballing," involves the direct instillation of alcohol into one or both eyes. Other alternative methods of alcohol consumption include smoking alcohol vapor or inhaling alcohol mist, instilling alcohol enemas, and inserting vodka tampons into the vagina (see Alternate routes of alcohol ingestion).1


The primary motive for using these alternative routes is to achieve greater intoxication at a faster rate, although this assumption is often incorrect. In the case of eyeballing, for example, the American Academy of Ophthalmology states that the amount of alcohol absorbed by the conjunctiva and cornea is too small to intoxicate a person quickly.2,3 Other reasons for non-oral alcohol consumption are to prevent detection of alcohol on one's breath, decrease caloric intake, and avoid vomiting or hangover symptoms.1


Of critical importance is the fact that some alternative methods of alcohol consumption, such as inhalation, increase the likelihood of alcohol poisoning because of the highly concentrated form of alcohol and the fact that alcohol enters the body without being metabolized in the liver via the gastrointestinal (GI) tract. As a result, blood alcohol levels may rise quickly, causing rapid and significant intoxication. Additionally, because these routes bypass the GI tract, including the stomach, the body cannot process the alcohol as a poison and vomit the excess.4

Table Alternate rout... - Click to enlarge in new windowTable Alternate routes of alcohol ingestion

In the case of vodka eyeballing, the corrosive effects of alcohol on the eye include corneal abrasions and scarring, promotion of ocular angiogenesis, and ocular infections. All of these adverse reactions can lead to vision loss.2,3 When corneal endothelial cells die due to direct alcohol exposure, the recovery of vision is uncertain. Patients who have engaged in eyeballing should be promptly examined by an ophthalmologist.3


New trends of administering alcohol spread quickly via social media and online platforms. Familiarity with information disseminated via social media networks may help healthcare professionals better understand their patients' perceptions, stay informed about the latest trends in alcohol abuse, and position themselves as more credible resources to their patients.1


Regardless of the route of alcohol consumption, nursing care for patients with alcohol toxicity includes close assessment of level of consciousness, vital signs (especially respiratory status), and blood alcohol level. In severe cases, hemodialysis may be necessary to clear the alcohol from the blood.


While obtaining a patient's health history, nurses must also document all routes of alcohol consumption. Knowing alcohol may have been ingested in ways other than drinking, clinicians can determine treatment plans, patient education, and referrals for substance abuse as appropriate.1




1. Ouellette L, Farley S, Rieth J, Riley B, Judge B, Jones J. Monitoring emerging toxicology trends using social media: eyeballing, vaportinis, and funneling. Am J Emerg Med. 2018;36(8):1517-1518. [Context Link]


2. Statement from the American Academy of Ophthalmology regarding "vodka eyeballing." American Academy of Ophthalmology. News release. June 1, 2010. http://www.aao.org/newsroom/news-releases/detail/statement-from-american-academy. [Context Link]


3. Bosmia AN, Griessenauer CJ, Tubbs RS. Vodka eyeballing: a potential cause of ocular injuries. J Inj Violence Res. 2014;6(2):93-94. [Context Link]


4. Braitman AL, Linden-Carmichael AN, Stamates AL, Lau-Barraco C. Sociocognitive factors and perceived consequences associated with alternative forms of alcohol use. J Am Coll Health. 2017;65(1):67-75. [Context Link]