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A 39-year-old man with blindness following the application of raw cassava extract to the eyes
Digital Journal of Ophthalmology 2009
Volume 15, Number 2
May 30, 2009
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Abdulkabir A. Ayanniyi, MBBS, FMCOph | University of Ilorin Teaching Hospital, Ilorin, Nigeria
Differential Diagnosis
1. Chemical eye injury was suspected in this patient as there was a history of eye exposure to cassava extract (a weak acid, pH 6.5). Moreover, the ocular symptoms rapidly worsened shortly after the administration of cassava extract.

2. Bacterial conjunctivitis/keratitis was also suspected in this patient especially by virulent pathogenic organisms such as Neisseria, Haemophilus, Klebsiella, and Pseudomonas. The onset of ocular symptoms was short, and the progression was rapid. However, the negative culture, although not absolute, lowered this suspicion.

3. Adult chlamydial conjunctivitis should not be ruled-out totally in this patient especially since the patient is from agrarian community where he may have been exposed to poor hygiene and inadequate sanitation. Still, lack of history of sexually transmitted disease in this patient, and the copious nature of the eye discharge weakened this differential.

4. Fungal conjunctivitis/keratitis was also a possible diagnosis in this patient. However, the history was unusual for fungal eye infection. One would expect ocular trauma involving vegetative material as well as slower onset.

5. Viral conjunctivitis could be entertained in view of the short duration and bilaterality of the eye presentation. However, the patient was not exposed to contagious adenoviral conditions including epidemic keratoconjunctivitis and acute hemorrhagic conjunctivitis. Moreover, the discharge was not serous.

6. Orbital cellulitis could also be entertained in this patient. There was, however, no history of sinusitis, subperiosteal abscess, facial injury, or penetrating orbital injury that could lead to orbital cellulitis in this patient.