Ocular Toxicity Secondary toAsclepias physocarpa: The Balloon Plant

Abstract

We report a case of a 65-year-old woman with symptoms of blurred vision and ocular irritation a few hours after accidental contact of the right eye with Asclepias physocarpa milky latex. Observation showed a diffuse conjunctival hyperemia and stromal corneal edema with Descemet's membrane folds. Recovery was fast and apparently complete in less than one month. However, specular microscopy at 6-months follow-up showed an abnormal endothelial morphology as sequelae, suggesting this condition is not as innocuous as it has been suggested.

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.…”

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.…”

Corneal endothelial dysfunction caused by Asclepias curassavica in a young farmer

“…In our patient, we used aggressive anti-inflammatory treatment including topical prednisolone acetate 1% and cyclosporine 0.1% as well as oral prednisolone. Although previous reports suggest that the corneal endothelial toxicity associated with cardenolides can resolve spontaneously, 1 , 2 and addition of topical steroid would be enough,1, 2, 3, 4 , 8 all the patients in the cases were elderly of 60 year or older. The young age of our patient could be associated with an increased risk of more aggressive inflammation and tissue destruction, while the patient was healthy enough to tolerate vigorous topical and systemic anti-inflammatory treatment.…”

“…In a case of Asclepias fruticosa exposure in a 73-year-old male farmer, marked improvement was observed at day 3 after the use of 0.1% topical dexamethasone, and corneal edema completely resolved at 2 weeks 1 . Almost complete recovery was also obtained after using topical dexamethasone, ofloxacin and artificial tears in a case of Asclepias physocarpa exposure in a 76 year-old female patient, 8 although there was a possibility of endothelial distress, such as, pleomorphism and polymegathism, as a sequelae at 6 months 8 . Mikkelsen et al 4 used topical chloramphenicol 0.5%, dexamethasone 0.1% and scopolamine 0.2% in a 70-year-old male patient who was exposed to Asclepias tuberosa, and reported that the corneal edema resolved after 96 hours 4 .…”

<p>Clinical Courses Of Corneal Endothelial Dysfunction Due To <em>Gomphocarpus physocarpus</em> Milky Latex-Induced Injury: A Case Series</p>

“……”

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.…”

Corneal endothelial dysfunction caused by Asclepias curassavica in a young farmer

“…In our patient, we used aggressive anti-inflammatory treatment including topical prednisolone acetate 1% and cyclosporine 0.1% as well as oral prednisolone. Although previous reports suggest that the corneal endothelial toxicity associated with cardenolides can resolve spontaneously, 1 , 2 and addition of topical steroid would be enough,1, 2, 3, 4 , 8 all the patients in the cases were elderly of 60 year or older. The young age of our patient could be associated with an increased risk of more aggressive inflammation and tissue destruction, while the patient was healthy enough to tolerate vigorous topical and systemic anti-inflammatory treatment.…”

“…In a case of Asclepias fruticosa exposure in a 73-year-old male farmer, marked improvement was observed at day 3 after the use of 0.1% topical dexamethasone, and corneal edema completely resolved at 2 weeks 1 . Almost complete recovery was also obtained after using topical dexamethasone, ofloxacin and artificial tears in a case of Asclepias physocarpa exposure in a 76 year-old female patient, 8 although there was a possibility of endothelial distress, such as, pleomorphism and polymegathism, as a sequelae at 6 months 8 . Mikkelsen et al 4 used topical chloramphenicol 0.5%, dexamethasone 0.1% and scopolamine 0.2% in a 70-year-old male patient who was exposed to Asclepias tuberosa, and reported that the corneal edema resolved after 96 hours 4 .…”

<p>Clinical Courses Of Corneal Endothelial Dysfunction Due To <em>Gomphocarpus physocarpus</em> Milky Latex-Induced Injury: A Case Series</p>

“……”

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.…”

Corneal endothelial dysfunction caused by Asclepias curassavica in a young farmer

“…In our patient, we used aggressive anti-inflammatory treatment including topical prednisolone acetate 1% and cyclosporine 0.1% as well as oral prednisolone. Although previous reports suggest that the corneal endothelial toxicity associated with cardenolides can resolve spontaneously, 1 , 2 and addition of topical steroid would be enough,1, 2, 3, 4 , 8 all the patients in the cases were elderly of 60 year or older. The young age of our patient could be associated with an increased risk of more aggressive inflammation and tissue destruction, while the patient was healthy enough to tolerate vigorous topical and systemic anti-inflammatory treatment.…”

“…In a case of Asclepias fruticosa exposure in a 73-year-old male farmer, marked improvement was observed at day 3 after the use of 0.1% topical dexamethasone, and corneal edema completely resolved at 2 weeks 1 . Almost complete recovery was also obtained after using topical dexamethasone, ofloxacin and artificial tears in a case of Asclepias physocarpa exposure in a 76 year-old female patient, 8 although there was a possibility of endothelial distress, such as, pleomorphism and polymegathism, as a sequelae at 6 months 8 . Mikkelsen et al 4 used topical chloramphenicol 0.5%, dexamethasone 0.1% and scopolamine 0.2% in a 70-year-old male patient who was exposed to Asclepias tuberosa, and reported that the corneal edema resolved after 96 hours 4 .…”

<p>Clinical Courses Of Corneal Endothelial Dysfunction Due To <em>Gomphocarpus physocarpus</em> Milky Latex-Induced Injury: A Case Series</p>

“……”