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Urvija Choudhary, Harsha Nagaraj, Rashmi Deshmukh, Rohit Shetty; TOXIC KERATITIS. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3901.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the effect, clinical features, management and prognosis of various ocular toxins on the cornea.
Twenty-seven patients presenting to Ophthalmology out patient department with features of toxic keratitis were studied retrospectively. Of these, 6 patients had exposure to custard apple seeds, 4 patients to podophyllin skin drops, 12 patients to calotropis plant juice, and 5 patients had ocular bee sting. Detailed clinical examination was done. Patients were treated using standard management protocol. Clinical features and visual outcomes were evaluated and described.
All injuries were accidental and patients did not have information that these were toxic to eyes and presented with symptoms of keratoconjunctivitis. Pain was a consistent feature in all cases except in majority of those exposed to calotropis juice. Custard apple seed exposure caused epithelial toxicity with high predisposition to keratitis and scarring with poor prognosis to topical steroids. Podophyllin toxicity was dose and duration dependent with effects involving only ocular surface and in some endothelial decompensation in severe cases. Calotropis mainly caused endothelitis with good response to topical steroids while presence of bee sting in the stroma led to progressive stromal melt.
The effect of these various toxins on the corneal layers helps us understand the pathophysiology of toxic keratitis and manage it better. Our study also describes the clinical prognosis of these toxins and emphasizes the need for patient and clinician education for prevention and management of the lesser-known toxins to prevent ocular morbidity.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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