The Spectrum of Ocular Inflammation Caused by Euphorbia Plant Sap

Abstract

To report the spectrum of clinical findings in patients with ocular inflammation caused by plant sap from Euphorbia species.Design: Clinical case series.Setting: Ophthalmology emergency referrals in the United Kingdom.Patients: We examined 7 patients, all of whom gave a history of recent ocular exposure to the sap of Euphorbia species.Interventions: All patients were treated with antibiotic drops or ointment (chloramphenicol). Cycloplegic and steroid drops were also used for some patients. Patients were observed until all signs and symptoms had resolved.Main Outcome Measures: Symptoms, visual acuity, and clinical signs of inflammation. All patients provided a specimen of the plant for formal identification.Results: Initial symptoms were generally burning or stinging pain with blurred vision. In most cases, visual acuity was reduced between 1 and 2 Snellen lines. In 1 patient with agerelatedmaculopathy,acuitydroppedfrom20/80tohandmotions before recovering. Clinical findings varied from a mild epithelial keratoconjunctivitis to a severe keratitis with stromaledema,epithelialsloughing,andanterioruveitis.Allsigns and symptoms had resolved by 1 to 2 weeks.Conclusions: These cases illustrate the range of severity of Euphorbia sap keratouveitis. The condition seems to be self-limiting when managed supportively. People who work with Euphorbia plant species should wear eye protection. Clinicians managing keratopathy caused by Euphorbia species should be aware of the danger of sight-threatening infection and uveitis, particularly during the first few days.

A Case of Acute Keratoconjunctivitis from Exposure to Latex of Euphorbia Tirucalli (Pencil Cactus)

“…In modern biomedical literature, reports of ocular toxicity have been reported in the German literature since 1940 but were first reported in English journals in 1964 (3,4,15). Since then, scattered case reports have appeared in the ophthalmology literature, with the largest being a clinical case series of seven patients (1). In addition to its direct ocular toxicities, toxic ingestions of Euphorbia plants have been associated with such adverse events as cardiac dysrhythmias, pulmonary edema, seizures, and death (10).…”

“…Widely distributed in all major continents, some of these plant species are commonly found as garden weeds and decorative house plants (1,2). Cases of ocular toxicity from direct eye contact with the latex have been reported in the ophthalmology literature since 1940, ranging from keratoconjunctivitis to blindness (1,(3)(4)(5)(6)(7)(8)(9)(10). Despite the common nature of this plant species and known toxicity of its latex within ophthalmology, this problem is not well known in Emergency Medicine.…”

Ocular Injuries from Plant Sap in Army Soldiers

“…Though there are more than 5000 plant species which contain sap, there have been instances of ocular injuries in humans resulting from accidental exposure to the genera of Euphorbia [1][2][3][4], Dieffenbachia [5], Hippomane [6], and Asclepias [7]. The toxicity is variable between and within genera and species.…”

“…Though many cases may be self-limiting without sequalae, the spectrum of ocular injuries due to plant sap splash vary from minimal discomfort to contact dermatitis, conjunctivitis, mild to severe keratitis, corneal ulceration, uveitis with hypopyon, corneal scarring, miosis and even blindness secondary to superimposed infection [1][2][3]. Our patients had received first aid at the incident site and were seen at the hospital within an hour and therefore serious sequelae were not encountered.…”

LC-MS2-Based dereplication of Euphorbia extracts with anti-Chikungunya virus activity

“…produce an irritant milky-white sap (latex), which acts as a chemical defense barrier when the plant is wounded. The toxicity of the latex to the skin, mucosae and eyes has been known since ancient time [22] and is still a common cause of gardening mishaps [23]. According to Greek and Roman literature, medical utilization of spurges included treatment of cancerous conditions, relieve of chronic pain and as drastic purgative [22,24].…”