Abstract
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.
Highlights
Surgeons may be unaware of the ability of plant toxins to cause corneal damage
The 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
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
Summary
Plants of the genus Asclepias are widely distributed, the number of the reports of ophthalmic disease due to plant toxins is surprisingly low. This may be attributable to the unfamiliarity of ophthalmologists to plant-based toxicity. The correct diagnosis was possible as symptoms were bilateral and the patient could report his exposure to plant toxins. If the symptoms had been unilateral or developed more immediately postoperatively, or if the patient had been unaware of plant toxins, he may have undergone unnecessary surgical interventions. Plant toxin-induced corneal damage is rarely encountered, all surgeons should be aware of this significant clinical condition
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