title: Corneal Toxicity Associated With Aquarium Coral Palytoxin.
abstract: OBJECTIVE
  To report a series of patients who developed corneal toxicity after exposure to aquarium coral palytoxin.
  
  
  METHODS
  Multicenter retrospective case series.
  
  
  METHODS
  Retrospective review.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Departments of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri.
authors: Asim V
authors: AV
authors: Farooq
authors: Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida.
authors: Allister G
authors: AG
authors: Gibbons
authors: Department of Ophthalmology, St. Louis University School of Medicine, St. Louis, Missouri.
authors: Matthew D
authors: MD
authors: Council
authors: Departments of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri; Departments of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri.
authors: George J
authors: GJ
authors: Harocopos
authors: Department of Ophthalmology, University of British Columbia, Vancouver, Canada.
authors: Simon
authors: S
authors: Holland
authors: Section of Ophthalmology, Pasqua Hospital, Regina, Canada.
authors: Jeffrey
authors: J
authors: Judelson
authors: Departments of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri.
authors: Bradley L
authors: BL
authors: Shoss
authors: Department of Ophthalmology, St. Louis University School of Medicine, St. Louis, Missouri.
authors: Eric J
authors: EJ
authors: Schmidt
authors: Department of Ophthalmology, University of British Columbia, Vancouver, Canada; Department of Ophthalmology, National University of Malaysia, Kuala Lumpur, Malaysia.
authors: Umi Kalthum
authors: UK
authors: Md Noh
authors: Department of Ophthalmology, St. Louis University School of Medicine, St. Louis, Missouri.
authors: Alexander
authors: A
authors: D'Angelo
authors: Department of Ophthalmology, St. Louis University School of Medicine, St. Louis, Missouri.
authors: Rao V
authors: RV
authors: Chundury
authors: Section of Ophthalmology, Pasqua Hospital, Regina, Canada.
authors: Richard
authors: R
authors: Judelson
authors: Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida.
authors: Victor L
authors: VL
authors: Perez
authors: Departments of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri. Electronic address: huanga@vision.wustl.edu.
authors: Andrew J W
authors: AJW
authors: Huang
mesh_terms: D000178:Acrylamides / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000818:Animals; D037421:Anthozoa / Q000737:chemistry*; D003064:Cnidarian Venoms; D005260:Female; D006801:Humans; D007634:Keratitis / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000095702:Polyether Toxins
chemical_list: D000178:Acrylamides; D003064:Cnidarian Venoms; C010272:palytoxin; D000095702:Polyether Toxins