MANCHINEEL KERATOCONJUNCTIVITIS

The Manchineel tree is an evergreen widely distributed in tropical reg ions. The toxic nature of Manchineel has been known since the early si xteenth century. Contact with its milky sap (latex) produces bullous d ermatitis and acute keratoconjunctivitis. We identified 19 patients wh o had ocular injuries caused by Manchineel between 1985 and 1990 and w ere able to review 12. All of these patients had been treated by lavag e, cycloplegia, and topical antibiotics. Of 20 episodes of exposure 14 affected both eyes. The cornea was damaged in 16 episodes, the extent varying from large corneal epithelial defects to superficial punctate keratitis. The epithelial changes had resolved in a mean period of 3. 75 days (range 1 to 14 days). Two episodes caused stromal infiltration to appear and in one of these a stromal opacity remained 5 years late r. The final visual acuity was 6/9 or better in all eyes except in one patient who had visual impairment because of glaucoma. Our results su ggest that despite the severity of the acute reaction, the long term v isual prognosis is excellent in Manchineel keratoconjunctivitis. The h istorical and toxicological literature on Manchineel is reviewed.