Ocular toxicity by latex of Calotropis procera (Sodom apple)

Abstract

We report the spectrum of ocular toxicity following accidental inoculation of latex of Calotropis procera (Sodom apple) in 29 eyes between January 2003 and December 2006. All patients presented with sudden painless dimness of vision with photophobia. Twenty-five (86%) patients had initial visual acuity of less than 20/60. All eyes had conjunctival congestion and mild to severe corneal edema with Descemet's folds. Three (10%) eyes had an epithelial defect, nine (31%) had iridocyclitis, and seven (24%) had associated secondary glaucoma. After treatment with topical corticosteroids, antiglaucoma agents, cycloplegics, hypertonic saline and tears supplements, 27 (93%) eyes recovered completely within 3-14 days. After three months, 17 (74%) out of 23 eyes showed a significant low endothelial cell count compared to the normal fellow eye ( P 0.001). The latex of Calotropis procera causes significant ocular morbidity which may be preventable by simple health education. The long-term effect on corneal endothelium has to be studied further.

Figure 1a

Flower and leaves of Calotropis procera

Figure 1b

Garland of Calotropis procera flowers to worship Lord Shiva

Figure 2a and 2b

Corneal edema and severe Descemet's folds in a patient after 48 hours

Figure 3a

Right eye of one patient: specular microscopy shows normal endothelial cell count and morphology

Figure 3b

Left eye of the same patient six month after the injury: specular microscopy shows polymegathism and pleomorphism with low endothelial cell count and increased corneal thickness