palytoxin and Keratitis

To report a series of patients who developed corneal toxicity after exposure to aquarium coral palytoxin.. Multicenter retrospective case series.. Retrospective review.. Seven patients presented with corneal findings ranging from superficial punctate epitheliopathy to bilateral corneal melt with subsequent perforation. Among those with mild corneal findings, resolution was achieved with topical steroids and lubrication, whereas some patients who developed progressive corneal melt required therapeutic penetrating keratoplasty. The history in all patients revealed exposure to aquarium zoanthid corals shortly before disease onset. A review of the literature revealed that there are few prior reports of coral-associated corneal toxicity and that some species of coral secrete a substance known as palytoxin, a potent vasoconstrictor that inhibits the membranous sodium-potassium ATPase pump across cell types and can cause rapid death if inhaled or ingested.. This is the largest case series to date demonstrating patients with aquarium coral palytoxin-associated corneal toxicity, and is the first to provide details of related histopathologic findings. Similar to other forms of toxic keratoconjunctivitis, a detailed history and careful clinical assessment are required, as well as timely removal of the offending agent from the patients' ocular milieu and environment. Mild ocular surface and corneal disease may be treated effectively with aggressive topical steroid therapy and lubrication. Given the potential severity of ocular as well as systemic adverse effects, there should be increased awareness of this entity among eye care professionals, aquarium enthusiasts, and the general public.

Topics: Acrylamides; Adult; Aged; Animals; Anthozoa; Cnidarian Venoms; Female; Humans; Keratitis; Keratoplasty, Penetrating; Male; Middle Aged; Retrospective Studies

Topics: Acrylamides; Animals; Anthozoa; Anti-Bacterial Agents; Aquaculture; Cnidarian Venoms; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Keratitis; Middle Aged; Occupational Diseases; Ofloxacin; Prednisolone

Although frequently observed in domestic saltwater aquariums, literature on exposure to palytoxin (PTX) of encrusting anemones (Zoanthidea) kept in aquariums is rare. Handling these animals for propagation purposes or during cleaning work can lead to dermal, ocular or respiratory contact with the PTX generated by some Zoanthids. The present study describes a case of ocular exposure to liquid from a Zoanthid, which led to corneal ulcers. The patient also suffered from systemic symptoms of dyspnea and shivering and a suspected rhabdomyolysis, which required monitoring in the Intensive Care Unit. After symptomatic treatment provided insufficient results, the corneal ulcers improved with an amniotic membrane transplantation. A review of the literature regarding ocular exposures to this diverse order of Hexacorallia reveals that severe and systemic symptoms can develop with minimal contact.

Topics: Acrylamides; Animals; Anthozoa; Bites and Stings; Cnidarian Venoms; Humans; Keratitis; Male; Middle Aged; Rhabdomyolysis; Tissue Transplantation