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 [].
A five-year-old female, child of a medical assistant working in a tertiary care teaching hospital in the Sultanate of Oman, underwent bilateral routine uneventful cataract extraction and posterior chamber intraocular lens implantation for congenital cataracts. She presented with painful red eyes two weeks post-surgery. The parents had discontinued the postoperative topical steroid (Prednisolone acetate 1%; Predforte® Allergan Inc, Irvine CA) administered four times daily and antibiotic drops (Ofloxacin 0.3% w/v; Exocin® Allergan, Irvine CA) administered four times daily and was instead treated with ‘Wasam’ treatment. At the time of presentation, the vision in the right eye was hand motions and the left eye was 1/50. Both eyes showed conjunctival congestion, corneal edema, retrocorneal membrane formation, posterior synechiae and secondary glaucoma (left eye 25 mmHg, right eye 40 mmHg). B scan ultrasound showed normal posterior segments in both the eyes.\nThere were two circular ulcerated areas on her occiput of about 4 cm diameter.\nThe child was hospitalized for over one month to control the intraocular inflammation, secondary glaucoma and to ensure that the ulcers on the occipital region healed (). Six months later, the secondary glaucoma had resolved, but vision remained unchanged (right eye hand motions and left eye, 1/50). The child had scars of ‘wasam’ in the occipital region.