Ocular toxicity by seeds of Annona squamosa (custard apple).
Custard apple seeds have been used in native medicine from time immemorial for the management of head lice and skin exfoliation. We report six consecutive patients who developed toxic keratoconjunctivitis within 6-12 h of ocular exposure to custard apple seeds. The use of topical steroid worsens the toxicity and predisposes to the development of microbial keratitis in such cases. Patients showed a good response to primary treatment with topical fortified antibiotics and lubricants. This case series highlights the need to educate the patients regarding the potential toxic effects of the custard seeds and the treating physicians about possible deleterious effects on using topical steroid.
Department of Cornea and External Eye Diseases, Narayana Nethralaya Superspeciality Eye Hospital and Post Graduate Institute of Ophthalmology, Bengaluru, Karnataka, India.
Harsha
H
Nagaraja
Department of Cornea and External Eye Diseases, Narayana Nethralaya Superspeciality Eye Hospital and Post Graduate Institute of Ophthalmology, Bengaluru, Karnataka, India.
Thungappa
T
Kugar
Department of Cornea and External Eye Diseases, Narayana Nethralaya Superspeciality Eye Hospital and Post Graduate Institute of Ophthalmology, Bengaluru, Karnataka, India.
Yathish
Y
Shivanna
Department of Cornea and External Eye Diseases, Narayana Nethralaya Superspeciality Eye Hospital and Post Graduate Institute of Ophthalmology, Bengaluru, Karnataka, India.
Archita
A
Agrawal
Department of Cornea and External Eye Diseases, Narayana Nethralaya Superspeciality Eye Hospital and Post Graduate Institute of Ophthalmology, Bengaluru, Karnataka, India.
Rohit
R
Shetty
D000328:Adult; D031041:Annona / Q000737:chemistry*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007637:Keratoconjunctivitis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D065346:Lubricant Eye Drops; D009824:Ointments; D012639:Seeds / Q000633:toxicity*
D000900:Anti-Bacterial Agents; D065346:Lubricant Eye Drops; D009824:Ointments
Indian J Ophthalmol. 2009 May-Jun;57(3):232-4
19384022
Food Chem. 2012 Dec 1;135(3):960-6
22953811
J Nat Prod. 1999 Mar;62(3):504-40
10096871
J Nat Prod. 1996 Jun;59(6):635-7
8786370
Ann Nutr Metab. 2005 Nov-Dec;49(6):407-13
16230844