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. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Background An estimated 49.8% of the world population will be myopic by 2050. Multifocal contact lenses (MFCLs) and orthokeratology (OK) reduce peripheral retinal hyperopic defocus, which animal studies have shown to positively impact eye growth. MFCLs are expected to slow myopic progression by 20 – 50% and OK by 30 – 60%, making them valuable therapeutic tools. In view of the guidelines for myopia management published by the International Myopia Institute in 2019, the aim of this retrospective data analysis of a tertiary care center was to review past experience with OK and MFCLs for myopia control and gain information to update current practice. Patients and Methods The contact lens (CL) database of the Eye Clinic of the University Hospital of Basel was searched with the label “myopia progression” between January 2012 – 2020. Patients were included if they gave informed consent, were younger than 19 years old at baseline, and had no ocular comorbidities that could potentially compromise vision. Primary outcomes were progression of spherical equivalent refraction for MFCL patients and progression of axial length (AL) for the OK group, comparing with historical data from OK trials. Secondary outcomes were the presence of risk factors for myopia, age, refractive error at baseline, follow-up duration, and adverse effects during therapy. Results Twenty-one patients could be included, with a mean age of 12.80 ± 3.32 years (y) at baseline. The majority of patients were older than 12 years and already myopic (− 3.89 ± 2.30 diopters) when control treatment was started. Overall, follow-up ranged from 0.08 to 6.33 years (2.03 ± 1.66 y). In the patients treated with MFCLs, myopia control improved significantly when patients changed from spectacles to MFCLs. In the OK group, 14% dropped out during the first year and 2 patients had multiple AL measurements during therapy, which showed a slower growth of AL when compared to other OK trials and controls with spectacles. There were two cases of non-severe keratitis. Environmental risk factors had not been documented and only 48% of clinical records had a documented family risk assessment. Conclusion Patients showed a slower myopia progression under MFCLs or OK, which supports their role as a treatment option in myopia management. In this regard, AL measurement is an important additional parameter to be included in the assessment of myopia progression in clinical practice. Identification of children at risk of developing high/pathologic myopia (family history, environmental risk factors) needs to improve so that the first stages of myopic shift can be recognized and targeted. Changes in lifestyle should be actively encouraged, especially when the impact of decreases in outdoor time secondary to COVID-19 is yet to become clear.

Our data suggest that changes in the structure of the corneal endothelium are different in the first three decades of life compared to later decades. Reasons for this could be mechanical and physical influences, changing biochemical properties of the cornea and aqueous humor, or the embryological origin of the endothelium. This observation shows that age generally is not a deciding factor for intraocular surgeries.

PurposeDown syndrome is a congenital anomaly caused by non‐dislocation of chromosome 21. Ocular features in trisomy 21 patients, such as changes in corneal collagen composition as well as thinning predisposing to keratoconus are well appreciated. We present a case of unilateral acute corneal hydrops in a young adult with trisomy 21, and the management to prevent corneal perforation yielding a successful visual outcome.MethodA 20‐year‐old man presented in our emergency department due to sudden visual loss and severe left ocular pain. Visual acuity was 20/200 in the right eye, and finger counting in the left. Anterior segment examination revealed pigmented endothelial cells and endothelial cell count reduced to 2583 CD/mm2 in the right eye, as well as a very large central corneal leukoma and corneal ectasia in the right eye. Corneal topography confirmed the presence of an acute corneal hydrops in the left eye as well as milder keratoconus in the right.ResultsApart from topical steroid drops, oral acetazolamide and timolol drops were used to reduce the intraocular pressure on a decompensated cornea with reduced endothelial cell count. Penetrating keratoplasty was eventually necessary. Due to intolerance and insufficient patient ability to use form‐stable contact lenses, a cross‐linking procedure was performed to stabilize the right eye. Both surgeries lead to best‐corrected acuity of 20/50 OU without a need for additional contact lens correction. Surface issues related to trisomy 21 were addressed using topical lubricants.ConclusionIn the presented case, preexisting keratoconus, worsened by frequent eye rubbing of abnormal collagen composition corneas, permits transmission of mechanical forces to thinner exposed tissue, leading to acute hydrops. The extensive corneal tissue damage that occurred with stromal scarring left necessitates keratoplasty to successfully restore vision. This case highlights the need for preventive ophthalmic examinations in patients of trisomy 21 to rule out the presence of keratoconus. The timely application of lubricants, as well as anti‐histamines and mast cell stabilizers could reduce the eye rubbing behavior that aggravates corneal anomalies in such mentally handicapped individuals. This may reduce progression and eventual need for surgical interventions.

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