Keratoconjunctivitis Following Application of Powder of Custard Apple Seeds on the Scalp for Treatment of Lice Infestation

Custard apple ( Annona squamosa ) seeds are traditionally used in India for lice treatment, but accidental ocular exposure can cause toxic keratoconjunctivitis. We report a 20-year-old female who developed pain, redness, watering, photophobia, and blurred vision in the left eye after applying custard apple seed paste on her scalp. Examination showed lid edema, conjunctival congestion, punctate epithelial erosions, corneal edema, and epithelial defect. She was managed with a topical fluoroquinolone, chloramphenicol with polymyxin B ointment, and homatropine eye drops. The defect healed, and vision improved on follow-up. Awareness of this harmful traditional remedy is vital to avoid misdiagnosis and inappropriate steroid therapy.