Ocular toxicity in human subjects through accidental exposure to latex of Euphorbia umbellata (Pax) bruyns

Two cases of ocular injury due to accidental exposure to latex and vapors of Euphorbia umbellata are described in this report. With the direct exposure of eyes to split drops of latex and inhalation exposure to vapors resulted in severe conjunctival congestion with bilateral peri-orbital edema without pain and inflammatory features with intense burning sensation of both the eyes, photophobia, blurred vision, severe redness with blepharospasm, intense thirst, nausea, and projectile vomiting. The symptoms reduced markedly after vomiting induced by the consumption of Nilavembu Kudineer, a Siddha poly herbal decoction. Redness of eyes relieved immediately with the instillation of mother's milk. It is construed that the presence of phorbol esters, a type of diterpenes in the latex of Euphorbia umbellata could have produced inflammatory responses by virtue of histamine, cytokine, and protease release which induced vomiting, pain, heat, and redness. This case report emphasizes the importance of using personal protective equipment such as goggles, gloves, and face mask while collecting and preparing medicines using the aerial parts of Euphorbia umbellata.