palytoxin and Corneal-Diseases

Palytoxin (PTX) is produced by corals such as zoanthid corals. Here we present a case of bilateral PTX-induced keratoconjunctivitis. A 63-year-old man presented to the emergency department with symptoms of red eye, purulent discharge, and foreign body sensation in both eyes. On slit lamp examination, epithelial defects in both eyes with a ring-shaped corneal stromal infiltrate in the right eye and a marginal stromal infiltrate in the left eye were noted. High-resolution anterior segment optical coherence tomography (HR-AS-OCT) showed stromal hyperreflectivity and Descemet folds. Bacterial, fungal, and amoebic cultures were taken. Empirical treatment with topical dexamethasone as well as antibiotics and systemic doxycycline was started. The next day the patient stated that he had been handling zoanthid coral without gloves and had rubbed his eyes afterward. Bilateral PTX-induced keratoconjunctivitis was diagnosed. His eyes were irrigated abundantly with saline solution, and umbilical cord serum eye drops were added to the treatment. Treatment was tapered according to improvement of the corneal infiltrates and epithelial defects. After four months, the stromal infiltrates were resolved but corneal scars persisted in both eyes. HR-AS-OCT showed anterior stromal hyperreflectivity corresponding to corneal leucomas. PTX can cause ocular adverse effects such as keratolysis and corneal inflammation, and in some cases can lead to corneal perforation. It can also produce systemic adverse effects, hence the importance of the preventive measures when handling corals that can produce this toxin.

Topics: Acrylamides; Cnidarian Venoms; Corneal Diseases; Humans; Keratoconjunctivitis; Male; Middle Aged; Tomography, Optical Coherence

A case is presented of corneal toxicity after exposure to palytoxin. A 42 year-old man came with symptoms of pain and blurred vision in his right eye. He reported that a zoanthid coral from a saltwater aquarium had squirted into his eye. Slit-lamp examination showed a prominent central ring infiltrate of 4×6mm without epithelial defect and satellite sub-epithelial micro-infiltrates. After 2 months of topical treatment with steroids, the stromal ring infiltrate was resolved, but a stromal thinning and residual fibrosis remained. Palytoxin is a potent vasoconstrictor that damages the ionic gradient of the cells, causing cell death. It is crucial to remove the toxin and start an aggressive topical therapy as soon as possible. In addition, considering the potential ocular and systemic adverse effects that this toxin can produce, it would be advisable to inform people of its existence and regulate the distribution of this type of corals.

Topics: Acrylamides; Adult; Animals; Anthozoa; Cnidarian Venoms; Corneal Diseases; Humans; Male