A 35-year-old lady, who worked in the royal stable, presented with redness and decreased vision in her right eye of 15 days duration. She was initially treated at a local health center for a corneal abrasion in her right eye, after being hit by the tail of a horse while cleaning the stable. She applied honey three times everyday to her painful right eye as advised by a local traditional healer. A week later, the pain in her eye decreased, but the vision in the right eye deteriorated and redness increased.\nAt the time of presentation, she had no pain or photophobia. The best corrected vision in the right eye was counting fingers at 2 m, and left eye was 0.5 with +2.0 D sph. The right eye showed ciliary congestion. A central corneal ulcer measuring (2 × 3 mm) in size with a hypopyon was noted. Culture of the scrapings from the ulcer grew dermatophytes on Sabouraud agar, which was identified as T. mentagrophytes. There was no evidence of superficial mycoses affecting skin, nails or any other area of her body.\nThe ulcer was treated with topical antifungal drops (Fluconazole 0.3%; Zocon® FDA Ltd) every hour, and cycloplegic (Cyclopentolate hydrochloride 1%; Mydrilate® Intrapharm) three times daily. Ten days following treatment, the patient underwent therapeutic keratoplasty for a non-healing corneal ulcer with impending perforation. The graft was clear and the eye quiet with a visual acuity of 0.2 on the first postoperative day. The topical medications were continued post-keratoplasty. However, the primary infection recurred involving the graft by the fourth postoperative day, progressing relentlessly to involve the entire graft by the 15th day resulting in a vascularized central scar by 2 months (). Posterior segment of the eye and the vitreous cavity appeared normal on B scan ultrasonography. Intra ocular pressure was 10 mmHg. The final visual acuity at the end of 2 months was appreciation of hand movements in the right eye.
A 74-year-old man presented to the Emergency Department at King Khaled Eye Specialist Hospital 3 days after self-application of latex from C. procera in his left eye (OS). He reported a painless decrease in vision. There was no history of previous trauma, surgery, or other ophthalmic disorder. Apart from hypertension, the patient had no medical illness.\nOphthalmic examination revealed best-corrected visual acuity of 20/40 in the right eye (OD) and hand motion vision in the OS. Intraocular pressure using applanation tonometry was within normal range in both eyes. Examination of the OD was unremarkable except for a mild cataract. Slit-lamp examination of the OS revealed quiet conjunctiva, no corneal epithelial defect, diffuse corneal edema with significant Descemet's folds and small pigmented keratic precipitates [ and ], nuclear sclerosis of the lens, and a hazy view of the fundus. B-scan ultrasonography of the OS showed no pathology of the posterior pole. Specular microscope SP-3000 P showed 2224 endothelial cells/mm2 in the OD and 593 cells/mm2 in the OS, with abnormal morphology.\nThe patient was started on topical prednisolone acetate 1% four times a day for the first week, after which it was tapered. In addition, topical cyclopentolate 1% drops three times a day were prescribed for the first 2 weeks. In the first follow-up at 1 week after presentation, his best-corrected visual acuity in the OS improved to 20/300. Slit-lamp examination showed a reduction in corneal edema and an increase in clarity with fewer Descemet's folds. In the second follow-up at 2 weeks after presentation, his best-corrected visual acuity improved to 20/200. Slit-lamp examination showed a clear cornea with no residual edema []. One month later, his best-corrected visual acuity was 20/80 in the OS. Six months later, the cornea remained clear with best-corrected visual acuity of 20/60 in the OS. The latex was sent for analysis and revealed the elements shown in . The result of phytochemical screening of petroleum ether and methanol leaf extracts of C. procera revealed the presence of glycosides, protein, triterpenoids, steroids, and flavonoids. The presence of these components in this species is an indication that it may have some medicinal potential. The latex of the C. procera was tested and was found completely varying in pH values. It has an acidic nature with pH of 4.2 at room temp of 25°C. The amount of magnesia was found in highest amount in latex. The level of chromium was completely absent [].