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Coral Keratitis: Case Report and Review of Mechanisms of Action, Clinical Management and Prognosis of Ocular Exposure to Palytoxin

Authors Barrett RT, Hastings JP, Ronquillo YC, Hoopes PC, Moshirfar M

Received 5 November 2020

Accepted for publication 9 December 2020

Published 12 January 2021 Volume 2021:15 Pages 141—156


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser

Ryan T Barrett,1 Jordan P Hastings,2 Yasmyne C Ronquillo,3 Phillip C Hoopes,3 Majid Moshirfar3– 5

1Hollingshead Eye Center, Boise, ID, USA; 2California Northstate University College of Medicine, Elk Grove, CA, USA; 3Hoopes Vision Research Center, Draper, UT, USA; 4John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA; 5Utah Lions Eye Bank, Murray, UT, USA

Correspondence: Majid Moshirfar
HDR Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, USA
Tel +1 801-568-0200

Abstract: Palytoxin is one of the most lethal natural toxins ever discovered. This molecule has been isolated from various marine animals, including zoanthid corals. This popular organism is commonly found in many home saltwater aquariums due to its beauty and survivability. As a result of an increase in popularity, an increased number of individuals are at risk for exposure to this potentially deadly toxin. Affected patients may experience various symptoms based on the route of exposure (ie, cutaneous contact, inhalation of aerosolized toxin, ocular exposure, or ingestion). Ocular exposure can occur in various ways (eg, contact with contaminated water, rubbing the eye with a dirtied hand, or direct spraying into the eye), and incidence rates have dramatically risen in recent years. In this review, we discuss a case of systemic toxicity from inhalation and ocular exposure to presumed palytoxin on a zoanthid coral which resulted in an intensive care unit (ICU) stay, and corneal perforation which required a corneal transplant. Additionally, we review what is known about the mechanism of action of this toxin, propose a comprehensive hypothesis of its effects on corneal cells, and discuss the prognosis and clinical management of patients with systemic symptoms secondary to other routes of exposure.

Keywords: coral keratitis, zoanthid, palytoxin, corneal perforation, case report

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