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Tom Eke, MA, FRCOphth; Sahar Al-Husainy, FRCS(Edin); Mathew K. Raynor, FRCS(Edin)

Arch Ophthalmol. 2000;118:13-16.

Objective  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 age-related maculopathy, acuity dropped from 20/80 to hand motions before recovering. Clinical findings varied from a mild epithelial keratoconjunctivitis to a severe keratitis with stromal edema, epithelial sloughing, and anterior uveitis. All signs 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.

From the Departments of Ophthalmology, Leicester Royal Infirmary (Mr Eke and Ms Al-Husainy) and Southampton Eye Unit (Mr Raynor), United Kingdom. Messrs Eke and Raynor were previously affiliated with the Taunton and Somerset Hospital, United Kingdom, where one of the patients was treated. None of the authors has a commercial interest related to this report.

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