Toxic keratopathy due to zoanthid coral palytoxin

Abstract

Purpose : To describe a series of patients that developed toxic keratopathy shortly after exposure to zoanthid coral.

Methods : Retrospective, multi-center case review.

Results : The corneal findings in seven patients exposed to aquarium coral palytoxin ranged from a mild reversible epitheliopathy to severe keratolysis and perforation. Treatment most commonly included topical steroids and topical antibiotics; in some cases, oral doxycycline, oral prednisone, amniotic membrane transplantation, corneal gluing, and/or corneal transplantation were employed. All patients provided a history of exposure to zoanthid corals, although in some cases this history was not elicited at the time of initial presentation. A review of the literature revealed that palytoxin is one of the most lethal substances in the world, and exposure can lead to severe systemic effects including respiratory failure and death.

Conclusions : Zoanthid coral palytoxin is a potential cause of severe toxic keratopathy. In patients presenting with signs suggesting a toxic exposure but without a clear etiology, a thorough history should include whether there has been recent contact with zoanthid coral species. Treatment should include aggressive anti-inflammatory medications, with a high index of suspicion for secondary infection. We recommend the use of personal protective equipment, including goggles and gloves, while handling zoanthid coral species.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.