Toxic corneal reaction due to exposure to palytoxin

Barbany, Míriam; Rossell, M.; Salvador, A. F.

doi:10.1016/j.oftale.2019.01.002

Cited by 4 publications

(6 citation statements)

References 9 publications

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“…Since the first case report published in 1993 [ 7 ], there have been additional articles [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ] (19 cases) published in English (with another 2 published in German [ 17 ] and Dutch [ 18 ]) discussing the manifestations of ocular exposure to PTX from coral reef. All known and reported cases of PTX keratoconjunctivitis are succinctly described in a table [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Toxic Keratoconjunctivitis from Coral Reef

Begaj

Tone

Ciolino

2021

Case Rep Ophthalmol

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A 25-year-old woman presented with right eye pain, lid edema, conjunctival injection and chemosis, and mild corneal epitheliopathy after exposure to fluid content from an aquarium coral reef. Topical moxifloxacin and prednisolone were started 4 times daily, with full clinical resolution after 2 weeks. Toxin-mediated keratoconjunctivitis may occur after exposure to zoanthid coral reef, particularly in aquarium enthusiasts. Topical corticosteroids in tandem with topical antibiotics appear to be effective in mild disease. However, in severe cases that exhibit corneal infiltrates and stromal thinning, close observation is warranted in case of possible keratolysis.

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Section: Discussionmentioning

confidence: 99%

Toxic Keratoconjunctivitis from Coral Reef

Begaj

Tone

Ciolino

2021

Case Rep Ophthalmol

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“…Other ocular manifestations observed are conjunctival and limbal ischemia, punctate bulbar and tarsal conjunctival hemorrhages, superficial corneal punctate epitheliopathy, corneal erosions, corneal infiltrates, corneal melting and perforation, and anterior chamber reaction. 2,3,4,5,6 Ocular exposure to PTX can occur by direct contact with the coral, contact with contaminated water, or rubbing the eyes after handing coral without gloves. In the presented case, the patient rubbed his eyes after manipulating zoanthids without using gloves.…”

Section: Discussionmentioning

confidence: 99%

“…Management is based on recommendations according to the severity of the case; a surgical intervention such as a corneal transplant may be necessary in cases of ulceration that result in corneal perforation. 2,3,4,5,6,7 We report a case of bilateral PTX-induced chemical keratoconjunctivitis, assessed by high-resolution anterior segment ocular coherence tomography in which umbilical cord blood serum (UCBS) eye drops were added as a complementary treatment.…”

Section: Introductionmentioning

confidence: 99%

Palytoxin-Related Keratoconjunctivitis Assessed by High-Resolution Anterior Segment Optical Coherence Tomography

Marti

Aragon-Roca

Trejo

et al. 2021

tjo

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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.

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“…There can be local inflammation with erythema and oedema from dermal exposure to intact or damaged skin 37 38. In humans, in addition to systemic signs, there may also be eye irritation with keratoconjunctivitis, oedema, pain, episcleritis, photophobia and corneal ulceration 39–44. Ocular signs can occur from handling the coral or from being squirted in the eye by fluid from the coral; recovery from ocular effects can take months 40 44…”

Section: Discussionmentioning

confidence: 99%

Paralytic shellfish poisoning and palytoxin poisoning in dogs

Bates¹,

Morrison²,

Flaig

et al. 2020

Veterinary Record

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BackgroundFatal cases of exposure to paralytic shellfish toxins and palytoxins have occurred in companion animals but are poorly described.MethodsWe describe one case of paralytic shellfish poisoning (PSP) and three cases of palytoxin poisoning in dogs.ResultsMild PSP occurred following ingestion of crab while walking on a beach. Analysis confirmed the presence of paralytic shellfish toxins, particularly decarbamoyl saxitoxin, in clinical samples and marine organisms. This case occurred shortly after an outbreak of PSP in dogs on the eastern coast of England. Palytoxin poisoning occurred in a dog after it chewed coral removed from an aquarium. Signs included collapse, hypothermia, bloody diarrhoea and respiratory distress. The dog was euthanised due to rapid deterioration and poor prognosis. Palytoxin was not detected in a premortem blood sample. Two other dogs in a separate incident developed only mild signs (fever and respiratory distress) after suspected exposure to aerosolised palytoxin and recovered within a few hours.ConclusionCases of PSP are episodic and not common in dogs. Cases of palytoxin exposure are reportedly increasing in humans, and there is presumably also an increased risk to pets. There is no specific treatment for PSP or palytoxin poisoning.

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Toxic corneal reaction due to exposure to palytoxin

Cited by 4 publications

References 9 publications

Toxic Keratoconjunctivitis from Coral Reef

Toxic Keratoconjunctivitis from Coral Reef

Palytoxin-Related Keratoconjunctivitis Assessed by High-Resolution Anterior Segment Optical Coherence Tomography

Paralytic shellfish poisoning and palytoxin poisoning in dogs

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