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Slit lamp photograph showing corneal edema and striate keratopathy on the day of presentation, 24 hours after exposure to Calotropis latex
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Calotropis procera produces copious amounts of latex, which has been shown to possess several pharmacological properities. Its local application produces intense inflammatory response. In the 10 cases of Calotropis procera -induced keratitis reported here, the clinical picture showed corneal edema with striate keratopathy without any evidence of in...
Citations
... [1,2] In India, it is more common in the states of Punjab, Bihar, Maharashtra, Rajasthan, Gujarat, and in South India. [3,4] These plants are used for their medicinal activity and the effect is either therapeutic or toxic depending on the mode of use and dose. [1,5] Flowers, garlands, and leaves of Calotropis plant are of Vedic significance and are used for worshipping Gods in India. ...
... [2] The plant exudes copious milky sap or latex. [2,4,6] Accidental contact during plucking of flower or inoculation of latex may cause inflammation of the eye resulting in toxic keratitis, endothelial cell damage, corneal edema and iridocyclitis. [2][3][4]6,7] The aim of this study was to describe the clinical profile of patients with ocular Calotropis poisoning presenting to a multitier ophthalmology hospital network in India. ...
... [2,4,6] Accidental contact during plucking of flower or inoculation of latex may cause inflammation of the eye resulting in toxic keratitis, endothelial cell damage, corneal edema and iridocyclitis. [2][3][4]6,7] The aim of this study was to describe the clinical profile of patients with ocular Calotropis poisoning presenting to a multitier ophthalmology hospital network in India. ...
Purpose:
To describe the clinical profile of patients with ocular Calotropis poisoning presenting to a multitier ophthalmology hospital network in India.
Methods:
This cross-sectional hospital-based study included 2,047,360 new patients presenting between August 2010 and March 2020. Patients with a clinical diagnosis of Calotropis poisoning in at least one eye were included. The data were collected using an electronic medical record system. Descriptive statistics using mean ± standard deviation and median with inter-quartile range (IQR) were used to elucidate the demographic data. Chi-square test was done for univariate analysis.
Results:
Overall, 362 (0.018%) new patients were diagnosed with ocular Calotropis poisoning during the study period. The mean age of the patients was 44.10 ± 18.61 years. The incidence rates were 0.013% in children and 0.018% in adults. Males were 57.46% and 87.29% had unilateral affliction. A significant number of patients presented from the rural geography (59.67%) and were from the higher socioeconomic class (72.65%). About a fourth of the patients were homemakers (23.48%) followed by agriculture workers (18.23%). Of the 408 affected eyes, 49.26% had mild visual impairment (<20/70) followed by moderate visual impairment (>20/70 to ≤ 20/200) in 23.28%. The most common clinical signs were conjunctival congestion (61.03%), descemet membrane folds (57.35%), stromal edema (30.39%), and corneal epithelial defect (24.51%).
Conclusion:
Calotropis poisoning in individuals seeking eye care in India is very rare. It is commonly unilateral and occurs more in the rural geography. It is common in middle-aged males and may affect vision due to involvement of the cornea.
... [1][2][3][4] Of these there have been many reports on Calotropis induced keratitis. 5 The latex of the Calotropis sap has been shown to be pro-inflammatory which results in endothelial toxicity causing stromal oedema. 6 The effects of orange juice splash into the eye have not been described in literature. ...
We report an unusual case of accidental splash of orange - rind juice in a 21 year old patient’s right eye leading to his complaints of redness, watering, photophobia and haze in the same eye within 24 hours.
On examination patient had an uncorrected visual acuity of 6/60 with slit lamp evaluation showing right eye mild conjunctival congestion and central corneal oedema with a normal overlying epithelium. Anterior segment OCT revealed central stromal oedema with a central corneal thickness of 660µm. pH of the right eye was 6 which returned to 7 on thorough eye wash with normal saline.
Patient was diagnosed with endothelial injury and started on topical steroid-prednisolone acetate 1% along with lubricating eye drops to which patient responded well. After 48 hours, slit lamp examination showed resolving stromal oedema with an improved uncorrected visual acuity of 6/18 in right eye.
Ophthalmologists need to evaluate the plant juice induced keratitis and identify the corneal layer primarily affected. Treatment varies depending on the layer affected. Endothelial dysfunction responds to topical steroids and early recognition helps in prompt institution of treatment and thus restoring the endothelial function.
... Calotropis keratitis commonly seen in the Indian subcontinent seen after accidental fall of whitish fluid while plucking the flower of the plant [55]. It may be localized or diffused and mostly presents as emergency having a perfectly normal vision before the fall. ...
Acute hydrops is a well-known complication of keratoconus. It usually manifests as sudden onset loss of vision. Mostly presents in the pubertal age group. Allergic conjunctivitis associated with eye rubbing is the most substantial risk factor. Primary pathology being stromal lysis, which triggers the progression of cone, causing an undue stretch on Descemet Membrane, eventually resulting in its splitting and stromal imbibition of aqueous through these ruptures. Clinical signs are circum-cillary congestion and thick/edematous cornea with obscuration of the anterior segment. Conservative therapy delays wound healing; hence early surgical intervention is recommended globally for faster resolution of stromal edema. Long-standing corneal edema mounts to corneal perforation and neovascularisation of cornea. Compressive suture, non expansile intracameral gas injection, Deep anterior lamellar keratoplasty, and mini Descemet membrane keratoplasty are various management modalities reported in literature. Acute hydrops could be well prevented with early identification of progressive keratoconus and halting its progression.
... However, several studies report that eye exposure can result in ocular toxicity. The extent of damage can range from kerato-conjunctivitis to complete visual loss [33,34,37] . Calotropis procera can also cause myocardial toxicity, the extent of which depends on the amount of cardio-active steroids ingested. ...
... [7] The irritant and pro-inflammatory properties of the milky white latex of C. procera have been well established. [8] Exposure to the latex irritates the mucous membrane and produces contact dermatitis and intense inflammation when injected locally in animal models. [8,9] Shivkar and Kumar [9] found that the injection of dried latex produces an intense inflammatory response involving edema and cellular infiltration in an animal model. ...
... [8] Exposure to the latex irritates the mucous membrane and produces contact dermatitis and intense inflammation when injected locally in animal models. [8,9] Shivkar and Kumar [9] found that the injection of dried latex produces an intense inflammatory response involving edema and cellular infiltration in an animal model. They showed that this response was caused by the presence of histamine in the latex itself, as well as the release of mast cell histamine by the latex. ...
We report a case of severe ocular injury and impaired vision after self-administration of alum. A 56-year-old female administered an alum substance in the left eye and experienced severe corneal thinning, a scar, and decreased vision. The active compounds in the alum substance were analyzed using scanning electron microscopy. When topically administered, alum may cause severe ocular injury. Public awareness, early recognition of the injuries, and timely intervention may prevent permanent ocular damage.
... The severity of visual loss was worse compared to the earlier series in which none of the patients had worse visual acuity than 20/200. [4,6] However, Basak et al. [7] reported <20/200 vision in 8 eyes of their 29 patients. There were no corneal epithelial defects and features of iridocyclitis in our case. ...
The use of Calotropis plant is widespread in the Indian system of Medicine (Ayurveda) and for religious purpose as an offering to Hindu god. Having an advantage of growing abundantly in unfavorable and harsh atmosphere, this shrub is easily found in many Indian states. We report here a case, in which a young boy developed severe corneal edema in both eyes following the application of Calotropis latex over the scalp area for the treatment of alopecia as prescribed by some Ayurveda practitioner. Patient responded well with the treatment including topical steroids with a complete resolution of corneal edema and persistent endothelial cell loss at the end of 6 weeks. This case report highlights the possibility of Calotropis-induced corneal endothelial toxicity while using it as an Ayurveda remedy and its management. Public education is must regarding this particularly in India where the use and availability of Calotropis shrub is widespread.
... [2] Calotropis procera (ushaar), a xerophytic shrub of the family Asclepiadaceae, is widely distributed in the tropics of Asia, Africa, and northwest South America. [3] It is medium branched and grows to a height of 4-5 m. The shrub has white or pink flowers [4] [ Figure 1a and b] and produces latex throughout. ...
... [5] On oral administration, it produces potent anti-inflammatory and analgesic effects, as well as weak antipyretic effects, whereas on local administration, it induces an intense inflammatory response in animal models. [3,6] These antagonistic biological activities (inflammatory and antiinflammatory) depend on the extraction medium and the route of administration of the latex in experimental animals. [3] Ocular injury caused by this plant can be mechanical but more commonly results from toxic exposure to the latex. ...
... [3,6] These antagonistic biological activities (inflammatory and antiinflammatory) depend on the extraction medium and the route of administration of the latex in experimental animals. [3] Ocular injury caused by this plant can be mechanical but more commonly results from toxic exposure to the latex. Accidental exposure has been reported to cause inflammation of the skin and eyes. ...
Calotropis procera (ushaar) produces a copious amount of latex, which has both inflammatory and anti-inflammatory pharmacological properties. Local application produces an intense inflammatory response and causes significant ocular morbidity. We report corneal toxicity following self-application of latex from C. procera in a 74-year-old man. He reported painless decreased vision in the affected eye with diffuse corneal edema, and specular microscopy revealed a reduced endothelial cell count. After he was treated with topical corticosteroids, his visual acuity improved from hand motion to 20/80. The composition of the active compounds in the latex was analyzed. When topically administered, the latex may cause severe ocular injuries and a loss of endothelial cells over a period of time. Public education, early recognition of such injuries, and timely intervention may prevent permanent ocular damage.
... Calotropis procera (ushaar), a xerophytic shrub of the family Asclepiadaceae, is widely distributed in the tropics of Asia, Africa, and northwest South America [3]. It is medium branched and grows to a height of 4-5 meters. ...
... The milky white endogenous latex exhibits a variety of effects in various animal models [5]. On oral administration, it produces potent anti-inflammatory and analgesic effects, as well as weak anti-pyretic effects, whereas on local administration, it induces an intense inflammatory response in animal models [3,6]. These antagonistic biological activities (inflammatory and anti-inflammatory) depend on the extraction medium and the route of administration of the latex in experimental animals [3]. ...
... On oral administration, it produces potent anti-inflammatory and analgesic effects, as well as weak anti-pyretic effects, whereas on local administration, it induces an intense inflammatory response in animal models [3,6]. These antagonistic biological activities (inflammatory and anti-inflammatory) depend on the extraction medium and the route of administration of the latex in experimental animals [3]. ...
... The latex of Calotropis procera contains several toxic compounds having irritant and pro-inflammatory properties [4,9,10]. The milky white latex of this plant irritates the mucous membrane and produces inflammatory reaction on local application or accidental exposure. ...
Introduction: Calotropis procera produces copious amounts of latex, which possesses several pharmacological properties. It produces severe inflammatory response on local application and its accidental instillation in the eye is associated with significant ocular morbidity. This is an observational study to assess the ocular toxicity of the latex of Calotropis procera and its management. Methods: 34 patients presenting to the ophthalmology department of a tertiary care centre of central India with exposure to the latex of Calotropis procera, were included in the study. Results: The main symptoms reported were burning, watering and discomfort. Corneal edema with striate keratopathy was found to be a universal manifestation with or without epithelial lesions and intraocular inflammation.The keratopathy showed good response to topical corticosteroids. Conclusion: Exposure to the latex of Calotropis procera is associated with significant ocular morbidity. The typical manifestation of striate keratopathy resolves with topical steroids. Simple health education in the form of hand washing, and avoiding eye contact and eye rubbing while plucking the flowers and leaves of Calotropis can prevent this injury.
... There are many reports of ocular calotropis toxicity which include keratoconjunctivitis, corneal abrasion, iridocyclitis, corneal edema following endothelial toxicity and secondary glaucoma (2,4,(5)(6)(7)(8). All the reports have emphasised on the endothelial toxicity of the calotropis and we did not find any report of ulcerative keratitis caused by calotropis. ...
