Calotropis Keratitis - KSOS

90 Kerala Journal of Ophthalmology Vol. XIX, No. 1
C A S E
REPORT
Calotropis Keratitis
Dr. Mohammed Haneef, MS DO, Dr Manoj Venugopal, MS, DNB, FRCS Edin,
Dr O U Mallika MS, DO, DNB, Dr Padma Sree K M MBBS
Introduction
Calotropis procera (‘Erukku’ in Malayalam) is a
commonly seen shrub with a world wide geographic
distribution. (Fig. 1) It is commonly harvested for its
medicinal properties. It exudes copious milky sap when
cut or broken. (Fig. 2) Ironically, the sap is highly irritant
to human tissues especially the skin and mucous
membrane 2 .
This article attempts to highlight the importance of
recognizing the damaging effects of this plant sap when
it comes into contact with the eye and therefore the
care one must take while handling this shrub.
Case Report
A thirty year old male who works in an Ayurvedic
pharmacy presented with defective vision, redness,
irritation and watering in his right eye following
accidental exposure to the milky sap of Calotropis
(Fig 3a & 3b). (The leaf of Calotropis is used in Ayurvedic
system of medicine for the treatment of joint
inflammations) Another twenty four year old male
presented with similar complaints in his right eye
following exposure to the sap while plucking the flowers
of Calotropis to make a garland out of it.(Fig 4 a & 4 b).
(The garland made from Calotropis flowers is offered
to the deity in temples)
Department of Ophthalmology, TD Medical College, Alleppey 688001
Phone no: O477 2251611 – 501 Extn
Both these patients had identical findings on the slit
lamp which revealed lid oedema in one of them due to
contact dermatitis, circum corneal congestion,
chemosis, corneal haze due to corneal oedema and
numerous Descemets Membrane folds. The corneal
epithelium was found to be intact. No significant
AC reaction was seen.The visual acuity was
CF 2M in the affected eye in the first case while it was
CF 4M in the second case. IOT was within the
normal range in both the eyes. Both the patients
responded well to topical Prednisolone Acetate.
Over a period of one week, cornea cleared well
and the visual acuity improved to 6/6in both the
patients
Review of literature revealed that intracorneal
penetration of Calotropis latex results in permanent
endothelial cell loss with its morphological alteration
as confirmed with confocal and specular microscopy 1 .
Corneal oedema is believed to resolve well if sufficient
viable endothelial cells are still present after resolution
of keratitis.
Conclusion
We wish to improve awareness of “ Calotropis keratitis”
amongst our fellow ophthalmologists , an entity which
to the best of our knowledge has not been reported
much in the literature.This plant due to its irritant sap
can result in corneal blindness when not carefully
handled.

March 2007 M. Haneef et al. - Calotropis Keratitis 91
Fig 1. Calotropis shrub
(a)
Fig 3 a & b. Patient 1 Gross & Slit lamp microscopy
(a)
Fig 4 a & b. Patient 2-Gross & Slit lamp microscopy
References
1. ‘Calotropis Procera keratitis’: Hani S Mezaine et al
Am J Ophthalmology 2004 Nov: 138: 875 – 6
2. Dietmar Brandes (2005) : Calotropis procera on
Fuerteventura www. bibilo.tu-bs.de/geobot/fuerte
Fig 2. Sap of the plant
(b)
(b)