Ocular Toxicity Secondary to<i>Asclepias physocarpa</i>: The Balloon Plant

Pina, S; Pedrosa, C; Santos, Cristina; Feijóo, Bernardo; Pêgo, P; Vendrell, Cristina; Santos, Maria João; Prieto, Isabel

doi:10.1155/2014/829469

Cited by 5 publications

(12 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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.…”

Section: Discussionmentioning

confidence: 82%

“…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 .…”

Section: Discussionmentioning

confidence: 90%

See 1 more Smart Citation

Corneal endothelial dysfunction caused by Asclepias curassavica in a young farmer

Lee

Han

Hyon

2019

American Journal of Ophthalmology Case Reports

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 90%

Corneal endothelial dysfunction caused by Asclepias curassavica in a young farmer

Lee

Han

Hyon

2019

American Journal of Ophthalmology Case Reports

View full text Add to dashboard Cite

show abstract

“…The plants of the Asclepias genus are widely distributed as horticultural or ornamental plants in Japan and other countries, and latex from their stems has been shown to contain toxic components termed cardenolides. To our knowledge, only a few cases of cardiolides toxicity have been previously reported [1–3], and general ophthalmologists are unaware of these plants. In corneal endothelial cells, the Na + /K + ATPase actively transports Na + from inside of the cells into the anterior chamber to create an osmotic pressure gradient; thereby resulting in the active transport of water from inside the corneal stroma to the anterior chamber.…”

Section: Discussionmentioning

confidence: 99%

“…The use of topical steroids may increase the activity of the Na + /K + pump in corneal endothelial cells [5] and thus have utility in the treatment of plant-induced corneal edema. Therefore, we modelled our treatment on the approach reported by Pina et al [1], with the patient almost completely recovering within 6 days. Our patient fully recovered without any sequelae including any damage to corneal endothelial cells.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Extensive bilateral corneal edema 6 weeks after cataract surgery: Keratopathy due to Asclepias physocarpa: a case report

Matsuura¹,

Hatta

Terasaka³

et al. 2017

BMC Ophthalmol

View full text Add to dashboard Cite

BackgroundSurgeons may be unaware of the ability of plant toxins to cause corneal damage. Therefore, corneal damage following intraocular surgery due to plant toxins may be misdiagnosed as postoperative infection.Case presentationA 74-year-old man presented with hyperemia and reduced visual acuity in both eyes 6 weeks after uneventful cataract surgery. We observed extensive hyperemia and corneal stromal edema with Descemet’s folds in both eyes.After obtaining a detailed patient history, we diagnosed plant toxin-induced corneal edema due to Asclepias physocarpa, which can induce corneal edema by inhibiting the Na+/K+ ATPase activity of the corneal endothelium.Antimicrobial and steroid eye drops and an oral steroid were prescribed accordingly. Symptons began to improve on day 3 and had almost completely resolved by day 6. At 1 month, the patient had fully recovered without any sequelae.ConclusionThe correct diagnosis was possible in the present case as symptoms were bilateral and the patient was able to report his potential exposure to plant toxins. However, if the symptoms had been unilateral and the patient had been unaware of these toxins, he may have undergone unnecessary surgical interventions to treat non-existent postoperative endophthalmitis.

show abstract

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

Yang

Beal²

2021

Cornea

View full text Add to dashboard Cite

To report a case of corneal milkweed toxicity on the corneal endothelium with epithelial damage in a pediatric patient. Methods:We report a case of a 13-year-old boy who presented to the emergency department with complaints of left eye pain and photophobia after direct corneal exposure to milkweed latex. He was found to have a large corneal epithelial defect and diffuse stromal edema suspected to be secondary to the cardiac glycosides present in the milkweed plant. Clinical examination and course are reported. Results:The patient was seen in the outpatient clinic on multiple visits. His epithelial defect had resolved within 3 days, and all corneal damage had healed within 18 days from injury. He was treated with antibiotic and steroid eye drops. Conclusions:Corneal exposure to cardiac glycosides from milkweed plants is known to damage the endothelial sodium-potassium pumps and to cause corneal edema and decreased visual acuity. All previously documented case reports of corneal milkweed toxicity are secondary to indirect exposure to the plant's latex. Here, we report the first case of corneal endothelial toxicity because of direct latex inoculation from an Asclepias plant and the first such toxicity reported in a pediatric patient.

show abstract

Ocular Toxicity Secondary toAsclepias physocarpa: The Balloon Plant

Cited by 5 publications

References 6 publications

Corneal endothelial dysfunction caused by Asclepias curassavica in a young farmer

Corneal endothelial dysfunction caused by Asclepias curassavica in a young farmer

Extensive bilateral corneal edema 6 weeks after cataract surgery: Keratopathy due to Asclepias physocarpa: a case report

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

Contact Info

Product

Resources

About