Manchineel keratoconjunctivitis.
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Journal: 1993/August - British Journal of Ophthalmology
ISSN: 0007-1161
PUBMED: 8318464
Abstract:
The Manchineel tree is an evergreen widely distributed in tropical regions. The toxic nature of Manchineel has been known since the early sixteenth century. Contact with its milky sap (latex) produces bullous dermatitis and acute keratoconjunctivitis. We identified 19 patients who had ocular injuries caused by Manchineel between 1985 and 1990 and were able to review 12. All of these patients had been treated by lavage, cycloplegia, and topical antibiotics. Of 20 episodes of exposure 14 affected both eyes. The cornea was damaged in 16 episodes, the extent varying from large corneal epithelial defects to superficial punctate keratitis. The epithelial changes had resolved in a mean period of 3.75 days (range 1 to 14 days). Two episodes caused stromal infiltration to appear and in one of these a stromal opacity remained 5 years later. The final visual acuity was 6/9 or better in all eyes except in one patient who had visual impairment because of glaucoma. Our results suggest that despite the severity of the acute reaction, the long term visual prognosis is excellent in Manchineel keratoconjunctivitis. The historical and toxicological literature on Manchineel is reviewed.
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Br J Ophthalmol 77(5): 284-288
PMID: 8318464

Manchineel keratoconjunctivitis.

Abstract

The Manchineel tree is an evergreen widely distributed in tropical regions. The toxic nature of Manchineel has been known since the early sixteenth century. Contact with its milky sap (latex) produces bullous dermatitis and acute keratoconjunctivitis. We identified 19 patients who had ocular injuries caused by Manchineel between 1985 and 1990 and were able to review 12. All of these patients had been treated by lavage, cycloplegia, and topical antibiotics. Of 20 episodes of exposure 14 affected both eyes. The cornea was damaged in 16 episodes, the extent varying from large corneal epithelial defects to superficial punctate keratitis. The epithelial changes had resolved in a mean period of 3.75 days (range 1 to 14 days). Two episodes caused stromal infiltration to appear and in one of these a stromal opacity remained 5 years later. The final visual acuity was 6/9 or better in all eyes except in one patient who had visual impairment because of glaucoma. Our results suggest that despite the severity of the acute reaction, the long term visual prognosis is excellent in Manchineel keratoconjunctivitis. The historical and toxicological literature on Manchineel is reviewed.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Adolf W, Hecker E. On the active principles of the spurge family, X. Skin irritants, cocarcinogens, and cryptic cocarcinogens from the latex of the manchineel tree. J Nat Prod. 1984 May-Jun;47(3):482–496. [PubMed] [Google Scholar]
  • LAUTER WM, FOX LE, ARIAIL WT. Investigation of the toxic principles of Hippomane mancinella, L. I. Historical review. J Am Pharm Assoc Am Pharm Assoc. 1952 Apr;41(4):199–201. [PubMed] [Google Scholar]
  • Woods B, Calnan CD. Toxic woods. Br J Dermatol. 1976 Jun;94(13 Suppl):1–97. [PubMed] [Google Scholar]
  • LAUTER WM, FOOTE PA. Investigation of the toxic principles of Hippomane mancinella L. II. Preliminary isolation of a toxic principle of the fruit. J Am Pharm Assoc Am Pharm Assoc. 1955 Jun;44(6):361–363. [PubMed] [Google Scholar]
  • Rao KV. Toxic principles of Hippomane mancinella. Planta Med. 1974 Mar;25(2):166–171. [PubMed] [Google Scholar]
Tennent Institute of Ophthalmology, Glasgow, Scotland.
Tennent Institute of Ophthalmology, Glasgow, Scotland.
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Abstract
The Manchineel tree is an evergreen widely distributed in tropical regions. The toxic nature of Manchineel has been known since the early sixteenth century. Contact with its milky sap (latex) produces bullous dermatitis and acute keratoconjunctivitis. We identified 19 patients who had ocular injuries caused by Manchineel between 1985 and 1990 and were able to review 12. All of these patients had been treated by lavage, cycloplegia, and topical antibiotics. Of 20 episodes of exposure 14 affected both eyes. The cornea was damaged in 16 episodes, the extent varying from large corneal epithelial defects to superficial punctate keratitis. The epithelial changes had resolved in a mean period of 3.75 days (range 1 to 14 days). Two episodes caused stromal infiltration to appear and in one of these a stromal opacity remained 5 years later. The final visual acuity was 6/9 or better in all eyes except in one patient who had visual impairment because of glaucoma. Our results suggest that despite the severity of the acute reaction, the long term visual prognosis is excellent in Manchineel keratoconjunctivitis. The historical and toxicological literature on Manchineel is reviewed.
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