Exposure to Euphorbia lathyris latex resulting in alkaline chemical injury: a case report

Abstract

IntroductionWe report the case of a patient with extreme pain following accidental exposure to the latex of Euphorbia lathyris.Case presentationA 76-year-old Caucasian woman attended the ophthalmology department with acute severe bilateral eye pain. This occurred immediately after having pulled a weed out of her garden with her bare hands. She recalled having subsequently rubbed her eyes. The offending plant, was brought into hospital and was identified as the Caper Spurge (Euphorbia lathyris). Her ocular pH was alkaline (pH 9). After copious irrigation, the pH normalised. She was treated with topical steroids, cycloplegics, lubricants and opioid oral analgesia. Three days later, she was symptom-free and her vision had returned to normal.ConclusionExposure to Caper spurge latex is a rare cause of keratoconjunctivitis. It can, however, potentially lead to corneal ulceration, anterior uveitis and rarely blindness. Treatment remains largely empirical. Exposure to the milky latex can result in extreme pain requiring prompt treatment. The use of goggles and gloves is recommended when handling this plant.

Use of an Amphoteric Solution in Eye, Skin and Oral Chemical Exposures: Retrospective Multicenter Clinical Case Series

“…Ophthalmological examination a few hours later showed only a mild conjunctival lesion. As compared to the case reported by Ioannidis et al [13], flushing with Diphoterine® solution resulted in a less severe lesion and rapid pain relief. Donoghue [5] compared the efficacy of Diphoterine® solution with that of water for decontamination of alkaline chemical splashes in a clinical study involving 180 workers.…”

“…Ioannidis et al [13] reported the case of a 76-year-old man with eye injury due to exposure to the latex of the Euphorbia lathyris plant. Despite flushing with 8 liters of normal saline followed by treatment with dexamethasone and cicatrizing eye drops, the patient developed a corneal ulcer and severe pain which necessitated a 3-day hospitalization.…”

Keratouveitis from Euphorbia cyparissias exposure is a temporal phenomenon

“…Another interesting report of Euphorbia toxicity involved the species Euphorbia lathyris 9. In that case, the authors reported that the patient’s ocular pH was alkaline which resulted in alkaline chemical injury as a result of exposure to the plant sap.…”

“…The patient, an avid gardener, remarked several times that the plant she had been pulling was of the Euphorbia genus. Further investigation into Euphorbia exposure revealed several references in the literature describing ocular toxicity and elevated pH secondary to exposure to the sap from this plant 9. The pH was measured in each eye and found to be 9 oculus dexter and 8 oculus sinister.…”

Ubiquitous euphorbia is anything but euphoria for the eye: a reminder to get any area of contact with the toxic sap under the tap

“…This species has previously been associated with alkali chemical injury and extreme pain. 1 Given its common use as ornamental houseplant and its presentation as a weed in UK gardens, this discussion aims to increase awareness among medical staff, nurses and gardeners and act as a reminder to implore about gardening history.…”