title: Dangerous waters: outbreak of eye lesions caused by fresh water sponge spicules.
abstract: OBJECTIVE
  To describe an extremely uncommon outbreak of eye lesions in a specific area of the Brazilian Amazonia.
  
  
  METHODS
  Prospective noncomparative case series. Fifty-nine patients who developed eye lesions after swimming in the Araguaia river of Tocantins state in Brazil were examined. A team of ophthalmologists equipped with a slit-lamp, gonioscopic lenses, and indirect ophthalmoscopy performed full eye examination. Analysis of the flora and fauna of the river water was undertaken by a group of experts.
  
  
  CONCLUSIONS
  Eighty-three eyes were affected. The most common lesions were corneal opacities seen in 34 eyes and conjunctival nodules diagnosed in 12 eyes. Severe visual acuity loss was detected in seven children with unilateral anterior chamber lesions. Spicules of the sponge species Drulia uruguayensis and Drulia ctenosclera were found inside three blind eyes that have been enucleated for diagnostic purposes. All eye lesions could be attributed to an outbreak of foreign bodies from fresh water sponges. Organic enrichment of the water resulting from the absence of sanitation probably was the key factor, which initiated a cycle of ecological imbalance that provoked human disease.
authors.affiliation: Department of Ophthalmology, University of São Paulo, Ribeirao Preto, São Paulo, Brazil. aavecruz@fmrp.usp.br
authors.forename: A A V
authors.initials: AA
authors.lastname: Cruz
authors.forename: V M
authors.initials: VM
authors.lastname: Alencar
authors.forename: N H
authors.initials: NH
authors.lastname: Medina
authors.forename: C
authors.initials: C
authors.lastname: Volkmer-Ribeiro
authors.forename: V L
authors.initials: VL
authors.lastname: Gattás
authors.forename: E
authors.initials: E
authors.lastname: Luna
mesh_terms: D000818:Animals; D000867:Anterior Chamber / Q000473:pathology; D001938:Brazil / Q000453:epidemiology; D002648:Child; D003229:Conjunctival Diseases / Q000175:diagnosis / Q000453:epidemiology*; D003318:Corneal Opacity / Q000175:diagnosis / Q000453:epidemiology*; D004196:Disease Outbreaks; D005129:Eye Foreign Bodies / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005618:Fresh Water; D006801:Humans; D008297:Male; D011161:Porifera; D011446:Prospective Studies; D012822:Silicon Dioxide; D014786:Vision Disorders / Q000175:diagnosis / Q000453:epidemiology; D014792:Visual Acuity
chemical_list: D012822:Silicon Dioxide