The spectrum of ocular inflammation caused by Euphorbia plant sap

Objective: To report the spectrum of clinical findings in patients with ocu lar 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 ocul ar 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 pa tients. Patients were observed until all signs and symptoms had resolved. Main Outcome Measures: Symptoms, visual acuity, and clinical signs of infla mmation. All patients provided a specimen of the plant for formal identific ation. Results: Initial symptoms were generally burning or stinging pain with blur red vision. In most cases, visual acuity was reduced between 1 and 2 Snelle n 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, e pithelial sloughing, and anterior uveitis. All signs and symptoms had resol ved 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 support ively. People who work with Euphorbia plant species should wear eye protect ion. Clinicians managing keratopathy caused by Euphorbia species should be aware of the danger of sight-threatening infection and uveitis, particularl y during the first few days.