Long-Standing Corneal Edema and Endothelial Decompensation due to Ecballium elaterium

The purpose of this study was to report the most severe documented ocular injury caused by Ecballium elaterium , an invasive and toxic herb characterized by an explosive seed dispersal.

A 55-year-old man presented to the emergency department several hours after direct exposure to the contents of E. elaterium to his left eye. Clinical examinations, investigations, and imaging findings are reported.

Medical and ocular histories were unremarkable. On presentation, the patient exhibited markedly decreased visual acuity, severe periorbital edema, conjunctival chemosis, and corneal edema. Although other signs gradually improved, corneal edema worsened despite rapid initiation of systemic and topical steroids and normal intraocular pressure. After 4 months of follow-up, the cornea cleared and visual acuity returned to normal; however, a significant decrease in endothelial cell count was observed.

Ecballium elaterium may cause a severe corneal chemical burn, with subsequent long-standing corneal edema and endothelial decompensation. Specular microscopy is a modality of great importance in these cases.