Cocaine, a prevalent drug of abuse, is associated with numerous systemic health complications, including significant ocular manifestations. These ocular effects range from mild to severe, with the potential for irreversible vision loss. Despite the extensive documentation of cocaine's systemic effects, the literature still lacks a focused review of its ocular manifestations. We methodically explore the epidemiology, pathophysiology, clinical presentations, diagnostic challenges, and therapeutic approaches related to cocaine-associated ocular manifestations. By categorizing the findings based on the anatomical location and type of pathology-orbital, corneal, retinal, neuro-ophthalmic, glaucoma-related, and uveal manifestations-we aim to provide a detailed overview that aids in early diagnosis and effective management of ocular disease secondary to cocaine use. Our review highlights the importance of awareness among clinicians, showcasing the wide range of ocular pathology to improve patient outcomes and prevent long-term ocular damage after cocaine abuse.