A 55-year-old man presented to the emergency room with chief complaints of decreased vision, severe pain, tearing, and photophobia of his left eye after administering a drop of Kermes topical eye drops, which he obtained from a homeopathic/folk medicine man. Apart from hypertension, the patient’s medical history was unremarkable.\nOphthalmic examination revealed best corrected visual acuity of 20/30 in the right eye (OD) and 20/200 in the left eye (OS). Examination of the OD was unremarkable except for mild cataract. Examination of OS revealed swelling and black pigmentation over the upper eyelid. There was conjunctival chemosis along with well-demarcated black elevated areas inferonasally. Evidence of early cicatrization involving the fornix of the conjunctiva and symblepharon formation were present. Some particulate material from the lower fornix was removed and submitted for chemical analysis. Administration of topical fluorescein hydrochloride revealed a large epithelial defect involving the whole cornea []. There was no evidence of perilimbal ischemia. Intraocular pressure was normal in both eyes.\nThe left eye was immediately irrigated with normal saline for 30 min. The patient was instructed to frequently lubricate the left eye with preservative-free artificial tears in addition to the administration of topical Ofloxacin 0.3% drops 4 times a day for 1 week and topical prednisolone acetate 1% 4 times a day for the first week then it was tapered. In addition, topical cyclopentolate 1% drops 2 times a day were prescribed for the first 2 weeks. Over the following several days, the patient’s best corrected visual acuity improved to 20/60. Eyelid swelling along with skin discoloration completely resolved. The corneal epithelial defect healed completely without scarring \n[].\nGas chromatography/mass spectrometry of the submitted sample revealed the main ingredient to be kermesic acid (C18H12O9) consistent with Kermes. In addition to kermesic acid, there were elements of barium, iron, manganese, potassium, and copper. Six months after presentation, symblepharon was still noted, however, the best corrected visual acuity OS was 20/25 without corneal scar.
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.