Corneal endothelial dysfunction caused by Asclepias curassavica in a young farmer

Abstract

PurposeTo introduce a case of corneal endothelial toxicity caused by Asclepias curassavica (Milkweed) in Korea.ObservationsA 37-year-old Asian man presented with decreased vision and redness in the right eye, which developed after contact with Asclepias curassavica. At presentation, best-corrected visual acuity (BCVA) was 20/60 in the right eye. Slit lamp examination demonstrated severe corneal stromal edema with Descemet's folds and conjunctival hyperemia. We prescribed topical prednisolone acetate 1% eye drops (8 times a day), cyclosporine 0.1% (once a day) and oral prednisolone (30 mg a day for 3 days). One day later, the BCVA improved to20/40 and marked improvement in corneal edema was observed. At 5 days, BCVA was 20/22 and anterior segment examination showed minimal corneal edema with resolution of Descemet's folds. At 2 weeks, BCVA was 20/20 in the right eye and corneal edema completely resolved.Conlcusions and importanceThis case suggests that high index of suspicion for toxicity from Asclepias species is necessary when encountered with patients who present with corneal edema after exposure to these plants. Aggressive anti-inflammatory treatment might be helpful for early recovery, at least for young patients.

Corneal Toxicity Secondary to Latex From Asclepias curassavica in a Pediatric Patient

“…Of the published case reports of milkweed corneal toxicity, the patient ages range from 37 to 74 years, and all patients experienced a significant improvement in symptoms within 3 days and showed resolution of corneal edema within 1 to 3 months. [2][3][4][5][6][7] Similarly, our patient showed resolution of epithelial defect and improvement in stromal edema 3 days after exposure to milkweed latex and complete resolution within 18 days. It is possible that our patient's young age and therefore robust corneal endothelial cells contributed to his rapid rate of recovery.…”

“…To the best of our knowledge, all published case reports of milkweed corneal toxicity are from indirect exposure that occurred from eye rubbing after earlier handling of the plant. 2–7 This is the first case report of direct corneal exposure to milkweed rather than an indirect exposure.…”

“…This is the first reported case of a corneal epithelial defect in the setting of corneal milkweed toxicity. [2][3][4][5][6][7] A few etiologies are plausible for the cause of the defect, including mechanical trauma, corneal bullae rupture, or a direct epithelial toxicity from the proteases in the plant latex. 8 Treatment for milkweed corneal toxicity currently includes steroid eye drops.…”

“…Previous case reports of corneal milkweed toxicity have shown resolution of corneal edema after application of topical dexamethasone 0.1%, prednisolone acetate 1%, or betamethasone 1%. [2][3][4]6,7 Of the 3 cases that were treated with topical dexamethasone 0.1%, resolution of corneal edema was seen after 270 days, 7 days, and 14 days. 2,4,6 Lee et al 3 administered their patient with topical prednisolone acetate 1% 8 times a day, cyclosporine 0.1% daily, and a three-day course of 30 mg/d of an oral steroid and saw resolution of corneal edema after 14 days.…”

“…2–4,6,7 Of the 3 cases that were treated with topical dexamethasone 0.1%, resolution of corneal edema was seen after 270 days, 7 days, and 14 days. 2,4,6 Lee et al 3 administered their patient with topical prednisolone acetate 1% 8 times a day, cyclosporine 0.1% daily, and a three-day course of 30 mg/d of an oral steroid and saw resolution of corneal edema after 14 days. Matsuura et al 7 administered their patient with betamethasone 1% 6 times a day and 10 mg/d of an oral steroid and saw resolution of corneal edema after 8 days.…”

Corneal Toxicity Secondary to Latex From Asclepias curassavica in a Pediatric Patient

“…Of the published case reports of milkweed corneal toxicity, the patient ages range from 37 to 74 years, and all patients experienced a significant improvement in symptoms within 3 days and showed resolution of corneal edema within 1 to 3 months. [2][3][4][5][6][7] Similarly, our patient showed resolution of epithelial defect and improvement in stromal edema 3 days after exposure to milkweed latex and complete resolution within 18 days. It is possible that our patient's young age and therefore robust corneal endothelial cells contributed to his rapid rate of recovery.…”

“…To the best of our knowledge, all published case reports of milkweed corneal toxicity are from indirect exposure that occurred from eye rubbing after earlier handling of the plant. 2–7 This is the first case report of direct corneal exposure to milkweed rather than an indirect exposure.…”

“…This is the first reported case of a corneal epithelial defect in the setting of corneal milkweed toxicity. [2][3][4][5][6][7] A few etiologies are plausible for the cause of the defect, including mechanical trauma, corneal bullae rupture, or a direct epithelial toxicity from the proteases in the plant latex. 8 Treatment for milkweed corneal toxicity currently includes steroid eye drops.…”

“…Previous case reports of corneal milkweed toxicity have shown resolution of corneal edema after application of topical dexamethasone 0.1%, prednisolone acetate 1%, or betamethasone 1%. [2][3][4]6,7 Of the 3 cases that were treated with topical dexamethasone 0.1%, resolution of corneal edema was seen after 270 days, 7 days, and 14 days. 2,4,6 Lee et al 3 administered their patient with topical prednisolone acetate 1% 8 times a day, cyclosporine 0.1% daily, and a three-day course of 30 mg/d of an oral steroid and saw resolution of corneal edema after 14 days.…”

“…2–4,6,7 Of the 3 cases that were treated with topical dexamethasone 0.1%, resolution of corneal edema was seen after 270 days, 7 days, and 14 days. 2,4,6 Lee et al 3 administered their patient with topical prednisolone acetate 1% 8 times a day, cyclosporine 0.1% daily, and a three-day course of 30 mg/d of an oral steroid and saw resolution of corneal edema after 14 days. Matsuura et al 7 administered their patient with betamethasone 1% 6 times a day and 10 mg/d of an oral steroid and saw resolution of corneal edema after 8 days.…”

Corneal Toxicity Secondary to Latex From Asclepias curassavica in a Pediatric Patient

“…Of the published case reports of milkweed corneal toxicity, the patient ages range from 37 to 74 years, and all patients experienced a significant improvement in symptoms within 3 days and showed resolution of corneal edema within 1 to 3 months. [2][3][4][5][6][7] Similarly, our patient showed resolution of epithelial defect and improvement in stromal edema 3 days after exposure to milkweed latex and complete resolution within 18 days. It is possible that our patient's young age and therefore robust corneal endothelial cells contributed to his rapid rate of recovery.…”

“…To the best of our knowledge, all published case reports of milkweed corneal toxicity are from indirect exposure that occurred from eye rubbing after earlier handling of the plant. 2–7 This is the first case report of direct corneal exposure to milkweed rather than an indirect exposure.…”

“…This is the first reported case of a corneal epithelial defect in the setting of corneal milkweed toxicity. [2][3][4][5][6][7] A few etiologies are plausible for the cause of the defect, including mechanical trauma, corneal bullae rupture, or a direct epithelial toxicity from the proteases in the plant latex. 8 Treatment for milkweed corneal toxicity currently includes steroid eye drops.…”

“…Previous case reports of corneal milkweed toxicity have shown resolution of corneal edema after application of topical dexamethasone 0.1%, prednisolone acetate 1%, or betamethasone 1%. [2][3][4]6,7 Of the 3 cases that were treated with topical dexamethasone 0.1%, resolution of corneal edema was seen after 270 days, 7 days, and 14 days. 2,4,6 Lee et al 3 administered their patient with topical prednisolone acetate 1% 8 times a day, cyclosporine 0.1% daily, and a three-day course of 30 mg/d of an oral steroid and saw resolution of corneal edema after 14 days.…”

“…2–4,6,7 Of the 3 cases that were treated with topical dexamethasone 0.1%, resolution of corneal edema was seen after 270 days, 7 days, and 14 days. 2,4,6 Lee et al 3 administered their patient with topical prednisolone acetate 1% 8 times a day, cyclosporine 0.1% daily, and a three-day course of 30 mg/d of an oral steroid and saw resolution of corneal edema after 14 days. Matsuura et al 7 administered their patient with betamethasone 1% 6 times a day and 10 mg/d of an oral steroid and saw resolution of corneal edema after 8 days.…”

Corneal Toxicity Secondary to Latex From Asclepias curassavica in a Pediatric Patient

“…Of the published case reports of milkweed corneal toxicity, the patient ages range from 37 to 74 years, and all patients experienced a significant improvement in symptoms within 3 days and showed resolution of corneal edema within 1 to 3 months. [2][3][4][5][6][7] Similarly, our patient showed resolution of epithelial defect and improvement in stromal edema 3 days after exposure to milkweed latex and complete resolution within 18 days. It is possible that our patient's young age and therefore robust corneal endothelial cells contributed to his rapid rate of recovery.…”

“…To the best of our knowledge, all published case reports of milkweed corneal toxicity are from indirect exposure that occurred from eye rubbing after earlier handling of the plant. 2–7 This is the first case report of direct corneal exposure to milkweed rather than an indirect exposure.…”

“…This is the first reported case of a corneal epithelial defect in the setting of corneal milkweed toxicity. [2][3][4][5][6][7] A few etiologies are plausible for the cause of the defect, including mechanical trauma, corneal bullae rupture, or a direct epithelial toxicity from the proteases in the plant latex. 8 Treatment for milkweed corneal toxicity currently includes steroid eye drops.…”

“…Previous case reports of corneal milkweed toxicity have shown resolution of corneal edema after application of topical dexamethasone 0.1%, prednisolone acetate 1%, or betamethasone 1%. [2][3][4]6,7 Of the 3 cases that were treated with topical dexamethasone 0.1%, resolution of corneal edema was seen after 270 days, 7 days, and 14 days. 2,4,6 Lee et al 3 administered their patient with topical prednisolone acetate 1% 8 times a day, cyclosporine 0.1% daily, and a three-day course of 30 mg/d of an oral steroid and saw resolution of corneal edema after 14 days.…”

“…2–4,6,7 Of the 3 cases that were treated with topical dexamethasone 0.1%, resolution of corneal edema was seen after 270 days, 7 days, and 14 days. 2,4,6 Lee et al 3 administered their patient with topical prednisolone acetate 1% 8 times a day, cyclosporine 0.1% daily, and a three-day course of 30 mg/d of an oral steroid and saw resolution of corneal edema after 14 days. Matsuura et al 7 administered their patient with betamethasone 1% 6 times a day and 10 mg/d of an oral steroid and saw resolution of corneal edema after 8 days.…”