ABSTRACT
The milky sap or latex of Euphorbia plant is highly toxic and an irritant to the skin and eye. This report illustrates the spectrum of ocular inflammation caused by accidental inoculation of latex of Euphorbia plant. Three patients presented with accidental ocular exposure to the milky sap of Euphorbia species of recent onset. The initial symptoms in all cases were severe burning sensation with blurring of vision. Visual acuity reduced from 20/60 to counting fingers. Clinical findings varied from kerato-conjunctivitis, mild to severe corneal edema, epithelial defects, anterior uveitis and secondary elevated intraocular pressure. All symptoms and signs had resolved by 10-14 days with active supportive medication. People who handle Euphorbia plants should wear eye protection. It is always advisable to ask the patient to bring a sample of the plant for identification.
Subject(s)
Aged, 80 and over , Corneal Diseases/drug therapy , Corneal Diseases/etiology , Corneal Edema/drug therapy , Corneal Edema/etiology , Corneal Edema/pathology , Epithelium, Corneal , Euphorbia/classification , Euphorbia/metabolism , Female , Gardening , Humans , Keratitis/drug therapy , Keratitis/etiology , Male , Middle Aged , Ocular Hypertension/drug therapy , Ocular Hypertension/etiology , Plant Exudates/adverse effects , Uveitis, Anterior/drug therapy , Uveitis, Anterior/etiology , Vision Disorders/drug therapy , Vision Disorders/etiologyABSTRACT
We report the spectrum of ocular toxicity following accidental inoculation of latex of Calotropis procera (Sodom apple) in 29 eyes between January 2003 and December 2006. All patients presented with sudden painless dimness of vision with photophobia. Twenty-five (86%) patients had initial visual acuity of less than 20/60. All eyes had conjunctival congestion and mild to severe corneal edema with Descemet's folds. Three (10%) eyes had an epithelial defect, nine (31%) had iridocyclitis, and seven (24%) had associated secondary glaucoma. After treatment with topical corticosteroids, antiglaucoma agents, cycloplegics, hypertonic saline and tears supplements, 27 (93%) eyes recovered completely within 3-14 days. After three months, 17 (74%) out of 23 eyes showed a significant low endothelial cell count compared to the normal fellow eye ( P 0.001). The latex of Calotropis procera causes significant ocular morbidity which may be preventable by simple health education. The long-term effect on corneal endothelium has to be studied further.
Subject(s)
Adult , Aged , Antihypertensive Agents/therapeutic use , Calotropis/adverse effects , Conjunctival Diseases/chemically induced , Conjunctival Diseases/diagnosis , Conjunctival Diseases/drug therapy , Corneal Edema/chemically induced , Corneal Edema/diagnosis , Corneal Edema/drug therapy , Female , Glaucoma/chemically induced , Glaucoma/diagnosis , Glaucoma/drug therapy , Glucocorticoids/therapeutic use , Humans , Iridocyclitis/chemically induced , Iridocyclitis/diagnosis , Iridocyclitis/drug therapy , Latex/adverse effects , Male , Middle Aged , Mydriatics/therapeutic use , Photophobia/chemically induced , Retrospective Studies , Vision Disorders/chemically induced , Visual AcuityABSTRACT
Introducción: La queratectomía con cauterización de la membrana de Bowman y el injerto de membrana amniótica son algunos de los tratamientos paliativos en pacientes con queratopatía bullosa dolorosa sin criterio de trasplante corneal. Describir los resultados de cada una de estas técnicas fue nuestro objetivo fundamental en este estudio. Métodos: Se realizó un estudio descriptivo con 34 pacientes con queratopatía bullosa dolorosa poscirugía de catarata. Se distribuyeron en dos grupos: queratectomía con cauterización de la membrana de Bowman y queratectomía con injerto de membrana amniótica con seguimiento por seis meses. Resultados: A los seis meses se mantenían sin bulas 64,7 y 41,2 por ciento de los casos con cauterización de la membrana de Bowman e injerto de membrana amniótica respectivamente. El incremento de la vascularización corneal fue mínimo para ambas técnicas quirúrgicas. Se logró el alivio de los síntomas en la primera semana de la cirugía para 82,4 por ciento en la cauterización de la membrana de Bowman y 94,1 por ciento en el injerto de membrana amniótica. A los seis meses de la cirugía se mantenían asintomáticos 88,2 y 70,6 por ciento de los casos con cauterización de la membrana de Bowman e injerto de membrana amniótica, respectivamente. La epitelización corneal se produjo antes de los 14 días en el 100 por ciento de los pacientes tratados con injerto de membrana amniótica y en el 94,1 por ciento de los pacientes con cauterización de la membrana de Bowman. Conclusiones: Ambas técnicas quirúrgicas fueron eficaces en el tratamiento a corto plazo de la queratopatía bullosa dolorosa poscirugía de catarata.
Introduction: Keratectomy with cauterization of Bowman´s membrane and the amniotic membrane graft are some of the palliative therapies to be applied in patients with painful bullous keratopathy without any criterion of corneal transplant. To describe the results of each technique was our fundamental objective in this study. Methods: A descriptive study of 34 patients with painful bullous keratopathy after cataract surgery was carried out. They were divided into two groups: one undergoing keratectomy with cauterization of Bowman´s membrane and the other amniotic membrane graft followed-up for six months. Results: After six months, 64.7 percent of cases with cauterization of Bowman´s membrane and 41.2 percent of those with amniotic membrane graft had no blebs. Increase of corneal vascularization as minimal for both techniques. The symptom relief in the first week of surgery was observed in 82.4 percent and 94.1 percent of cases respectively. After six months, the patients kept asymptomatic in 88.2 percent of cases with cauterized Bowman´s membrane and 70.6 percent of amniotic membrane grafts. Corneal epithelization occurred before 14 days of surgery in 100 percent of patients treated with graft and in 94.1 percent of cauterized cases. Conclusions: Both surgical techniques are effective in short-term treatment of painful bullous keratopathy after a cataract surgery.
Subject(s)
Humans , Middle Aged , Amnion/surgery , Corneal Edema/surgery , Corneal Edema/drug therapy , Bowman Membrane/surgery , Epidemiology, DescriptiveABSTRACT
Objetivo: Descrever um caso atípico de descompensação corneana tardia e localizada, por fragmento de núcleo cristaliniano após facoemulsificação. Local: Departamento de Córnea, Fundação Altino Ventura, Recife - PE. Método: Relato de caso. Resultado: Houve regressão do edema corneano e melhora da acuidade visual, após remoção cirúrgica do fragmento de cristalino localizado na câmara anterior. Conclusão: Os autores alertam para a possibilidade de edema corneano tardio e conseqüente diminuição da acuidade visual, relacionada ao fragmento cristaliniano remanescente, o qual pode se deslocar de uma câmara para outra, tornando difícil seu diagnóstico etiológico precoce.