Transient corneal edema from exposure to milkweed (Asclepias curassavica)

Abstract

A 30-year-old florist presented at Mass Eye and Ear with blurry vision in her left eye. Symptoms began several hours earlier, after she touched her eye while preparing a bouquet that included tropical milkweed, Asclepias curassavica (A, representative bouquet with bloomed and unbloomed milkweed). Visual acuity in the affected eye was 20/40. Anterior segment examination (B) and optical coherence tomography (C) showed diffuse corneal stromal edema, Descemet membrane folds, no corneal epithelial defect, and diffuse conjunctival injection. She was treated with topical prednisolone acetate 1% and sodium chloride 5% drops, each 4 times daily. Two days later, the edema had resolved (D), and visual acuity improved to 20/20. Plants in the genus Asclepias contain cardiac glycosides in their milky latex, stems, and leaves, which inhibit the Na⁺-K⁺-ATPase enzyme found in the corneal endothelium and can cause endothelial decompensation and stromal edema.