Public education is needed to help prevent toxic keratitis after hair washing with crushed custard apple seeds to remove head lice, a common practice in developing countries, according to a study.
A retrospective review over a 3-year period of patients presenting to the Aravind Eye Hospital in India with toxic keratitis and a clear history of crushed custard apple seed application identified 19 patients with acute disease either unilaterally or bilaterally.
“We hypothesized that toxic keratopathy was due to either toxic or mechanical insult of the crushed custard apple seeds to corneal epithelium. Patients presented to us in an emergency state, mostly within 24 hours, requiring immediate medical attention indicating the acuteness and the toxic effect of the disease,” the authors said.
Presentation characteristics included ocular pain, defective vision, tearing and photophobia. Symptoms resolved in all patients after treatment with 0.3% ofloxacin eye drops in a median time to heal of 5 days, with no residual scar or corneal infection.
“This smooth recovery can be attributed to the fact that there was a clear history, immediate presentation of the patient and prompt management with prophylactic antibiotics,” the authors wrote.
Disclosures: The authors report no relevant financial disclosures.