History: A 53-year-old man presents to the ED for one day of right eye burning and redness that is associated with blurry vision, which only started in the past 2 hours. He had been seen earlier the same day for severe burning in that eye after rubbing it with a finger that had been lightly contaminated by sap from a succulent plant that had oozed liquid onto his hands while he was gardening. At the time of his initial visit, his eye had not been as bad as it is now and his vision had been normal.
Exam: See Figure above. His vision in the involved eye was 20/20 earlier, but now it is 10/200 (he must be 10 feet from eye chart to see the big “E” at the top). His vision is no better even when the goop in his eye is cleared away. His cornea shows no fluorescein uptake.
What should be the initial treatment?
What type of succulent sap did this patient most likely get in his eye?
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2. Eke T, Al-Husainy S, Raynor MK. The spectrum of ocular inflammation caused by Euphorbia plant sap. Arch Ophthalmol. 2000;118:13-16. doi:10.1001/archopht.118.1.13