Palytoxin Keratitis

Palytoxin keratitis means the clear window at the front of your eye (the cornea) becomes damaged and inflamed after the eye touches palytoxin. Palytoxin is a powerful toxin that some aquarium corals can release—especially zoanthid or palythoa corals. People can be exposed when they handle, cut, scrub, or boil live rock or corals, or when coral fluid splashes into the eye. Even being very close to coral that’s been heated (for example, during cleaning) can release fumes that irritate eyes and airways. NCBICDCCORAL Magazine

Palytoxin keratitis (also called coral keratitis or palytoxin-induced keratoconjunctivitis) is an eye surface injury caused by a marine poison called palytoxin. The toxin is made by some soft corals (especially zoanthid and Palythoa corals) that people keep in salt-water aquariums or encounter in the ocean. When tiny amounts of this toxin reach the eye—by a splash from tank water, a direct “squirt” from a coral polyp, rubbing the eye with contaminated fingers, or exposure to aerosol/steam during cleaning—it irritates and damages the clear front window of the eye (the cornea) and the pink lining (the conjunctiva). This is not an infection at the start. It is a toxic chemical injury that can look like an infection because it causes pain, redness, light sensitivity, tearing, and blurry vision. In mild cases, the damage is shallow. In severe cases, the cornea can melt, ulcerate, or even perforate without rapid care. Reports have increased as reef-keeping has become more popular. NCBIPMC

How it harms cells (the short version): palytoxin binds to the sodium-potassium pump (Na⁺/K⁺-ATPase) on cell membranes and turns it into an open ion channel. This collapses the cell’s normal salt balance and can trigger cell death and strong inflammation. It also disturbs actin microfilaments, which slows healing. In the cornea this shows up as punctate erosions, ring-shaped stromal inflammation, Descemet’s membrane folds, and in bad cases corneal thinning and perforation. NCBIPMC

Who gets it: most reported patients are aquarium hobbyists, shop workers, divers, or marine biologists. Inhalation/aerosol exposures during cleaning and direct ocular exposures have both been reported; systemic (whole-body) symptoms like metallic taste, fever, cough, and shortness of breath can occur with significant exposures in the same setting. CDCNCBI

Palytoxin harms cells by attaching to a pump on their surface (the sodium–potassium pump) and turning it into an open channel. This makes salt and water rush the wrong way into the cell, which swells and dies. In the cornea, this leads to surface defects, deeper white streaks or rings inside the cornea, and sometimes ulcers. The inflammation can be intense and can also raise eye pressure. Because it looks like other causes of corneal ulcers or “ring infiltrates,” a good history of coral or aquarium exposure is crucial to make the diagnosis. PubMed

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Types

There is no official grading scale just for palytoxin keratitis, so clinicians describe it by how the exposure happened and how deep/severe the eye damage is. The following “types” are a simple, helpful way to think about it:

1. By exposure route

   • Direct splash/squirt type: coral fluid or tank water hits the eye. Often one eye. On exam, doctors may see conjunctival injection, punctate erosions, and sometimes a ring-shaped stromal infiltrate. NCBI

   • Hand-to-eye transfer type: person handles zoanthids and then rubs the eye. Can be one or both eyes; history is the clue. Turkish Journal of Ophthalmology

   • Aerosol/steam type: cleaning or killing corals with hot water, vigorous scrubbing, or power-washing creates airborne droplets; eyes and airways are exposed. Can be bilateral and may include systemic symptoms (fever, cough). CDC

   • Dust/particulate type: dry coral “dust” or debris becomes airborne during moving/fragging and gets into the eye. PMC

2. By laterality

   • Unilateral (one eye): common after a direct splash/squirt.

   • Bilateral (both eyes): more common with aerosol/steam or hand-to-eye transfer after handling both eyes. Turkish Journal of Ophthalmology

3. By severity (depth of injury)

   • Epithelial-predominant (mild): mainly surface punctate erosions, pain, photophobia; often improves quickly with early care.

   • Stromal-ring (moderate): ring-shaped inflammatory infiltrate and corneal swelling; healing is slower and needs closer follow-up.

   • Keratolysis/ulcer (severe): stromal melt, thinning, or ulceration; risk of perforation and scarring. NCBI

4. By complications

   • With anterior uveitis/iritis.

   • With limbal stem-cell failure (rare but vision-threatening).

   • With secondary infection superimposed (can occur later). NCBI

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Causes

Think of “cause” here as how the toxin actually reaches the eye or what makes the injury more likely or worse.

1. Direct squirt from a zoanthid/Palythoa polyp into the eye during handling or fragging. PMC

2. Tank water splash that contains palytoxin (e.g., during water changes). NCBI

3. Rubbing the eye with contaminated fingers after touching corals. Turkish Journal of Ophthalmology

4. Aerosol/steam exposure when boiling or using hot water to kill/remove coral, with droplets settling on the eye. CDC

5. Vigorous scrubbing, brushing, or power-washing live rock with zoanthids, producing spray that hits the eyes. CDC

6. Mouth-siphoning aquarium water and then touching the eyes, or accidental splash during siphoning. CDC

7. Airborne coral dust/particles from dried or disturbed colonies that get into the eyes. PMC

8. Handling zoanthids without gloves, then removing/adjusting contact lenses, smearing toxin onto the lens/eye. Turkish Journal of Ophthalmology

9. Wearing contact lenses at the time of exposure, which can hold toxin against the cornea longer. NCBI

10. Delayed eye irrigation after exposure, allowing deeper penetration. (Case reports stress early irrigation.) NCBI

11. High-concentration species or large colonies with more toxin (some Palythoa can be highly toxic). CDC

12. Working close to running pumps/protein skimmers that aerosolize water during coral manipulation. NCBI

13. Breaking live rock with attached zoanthids (hammering/cutting) and splashing the eye. CDC

14. Accidental transfer from contaminated tools (tweezers, scissors) to the eye area. (Plausible in case series context.) PMC

15. Ocean splash while diving/collecting near zoanthids. NCBI

16. Working in coral aquaculture or research with frequent exposure to colonies and fluids. Cureus

17. Using hot tap water or heat guns on corals, creating toxic mist that reaches the face. CDC

18. Cross-contamination during irrigation (washing one eye spreads toxin to the other via hands/skin). NCBI

19. Pre-existing tiny surface defects (dry eye, micro-abrasions) that make penetration easier. (Mechanism-consistent.) NCBI

20. Exposure to other palytoxin-producing organisms (e.g., Ostreopsis algal blooms) with marine aerosols irritating the eyes. CDC

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Symptoms

Symptoms vary with dose, contact time, and whether the airway was also exposed.

1. Sudden eye pain or burning soon after exposure. NCBI

2. Red eye (bloodshot appearance). NCBI

3. Watering/tearing (the eye keeps making tears). NCBI

4. Light sensitivity (bright lights hurt). NCBI

5. Blurred or hazy vision. NCBI

6. Foreign-body sensation (feels like sand in the eye). NCBI

7. Eyelid swelling and soreness. NCBI

8. Mucous or purulent discharge (not always present early). PMC

9. Headache around the eye. PMC

10. Decreased vision if the cornea swells or ulcerates. NCBI

11. Metallic or bitter taste in the mouth (a warning sign of systemic exposure). CDC

12. Fever, chills, or feeling unwell with larger exposures (often from aerosols). CDC

13. Cough or shortness of breath if the lungs were also exposed. CDC

14. Sensitivity to touch over the eye (from surface injury/inflammation). NCBI

15. Photophobia-related squinting and trouble keeping the eye open. NCBI

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Diagnostic tests

There is no single “positive palytoxin test” in human patients. Diagnosis is clinical: a clear exposure history plus typical eye findings and negative infectious studies. Tests help confirm the pattern, rule out infection, and check for complications. NCBI

A) Physical examination

1. Visual acuity (Snellen chart).
   Measures how clearly you see. Baseline and follow-ups show if vision is improving or if deeper injury/scar is limiting sight. NCBI

2. External eye and eyelid inspection.
   Looks for eyelid swelling, redness, discharge, and periocular skin irritation after exposure.

3. Conjunctival/limbal exam under white light.
   Checks for conjunctival injection, limbal whitening or spots, and hemorrhages sometimes reported in coral injuries. NCBI

4. Pupil reactions (light reflex).
   Ensures inflammation hasn’t spread deeper (which can affect iris function).

5. Intraocular pressure (tonometry).
   Detects pressure changes if inflammation involves the front of the eye.

6. Ocular surface pH strip.
   Many cases show normal pH, but occasional cases show elevated pH at first; documentation guides immediate rinsing. NCBI

B) Manual slit-lamp–based tests

7. Slit-lamp biomicroscopy with fluorescein dye.
   This is the key bedside test. It shows punctate epithelial erosions, defects, ring-shaped stromal infiltrates, and Descemet’s folds characteristic of toxic injury from palytoxin. NCBI

8. Seidel test (leak test) with fluorescein.
   Screens for corneal perforation in severe melt/ulcer cases.

9. Eyelid eversion and fornix sweep.
   Looks for trapped particles (e.g., dried coral dust) and lets the clinician remove debris that keeps irritating the surface. PMC

10. Corneal sensitivity (Cochet-Bonnet esthesiometry or cotton wisp).
    Checks corneal nerve function; toxic keratopathy can reduce sensitivity when injury is deeper.

11. Pinhole visual acuity.
    Helps separate refractive blur from true corneal haze/opacity.

C) Laboratory & pathologic studies

12. Corneal scraping for Gram stain and bacterial culture.
    Most palytoxin cases have negative cultures, but this rules out primary bacterial keratitis or a secondary infection layered on top. NCBI

13. Fungal microscopy/culture (KOH prep).
    Rules out fungal keratitis in atypical or slow-to-improve cases. Turkish Journal of Ophthalmology

14. Acanthamoeba testing (culture/PCR) when contact lenses are involved.
    Contact lens wear increases exposure time to toxin, and clinicians also exclude amoebic infection when findings are unusual. NCBI

15. General blood work if systemic symptoms (CBC, CRP).
    Case clusters of aerosol exposure report fever and leukocytosis in some patients. CDC

16. Creatine kinase (CK) and urine myoglobin if very unwell.
    Rare reports link severe systemic exposure to rhabdomyolysis; labs help detect it. NCBI

D) Electrodiagnostic & physiologic monitoring

17. Electrocardiogram (ECG) and continuous pulse oximetry in patients with significant aerosol exposure or metallic taste, dyspnea, or chest symptoms—to watch for cardiac or respiratory effects described in public-health investigations. NCBICDC

18. Respiratory monitoring (e.g., peak flow/oximetry during observation) when there are cough/shortness of breath complaints from the same exposure event. (Assesses safety and recovery.) CDC

E) Imaging tests

19. High-resolution anterior segment OCT (AS-OCT).
    Non-contact imaging that shows stromal hyper-reflectivity, Descemet’s folds, and corneal thickness, helping track thinning and recovery. Turkish Journal of Ophthalmology

20. Pachymetry / corneal tomography.
    Measures corneal thickness to monitor for melt or perforation risk; guides the urgency of intervention. Turkish Journal of Ophthalmology

Non-pharmacological treatments

These are non-medicine steps your eye team may use alongside medications. Each item includes description, purpose, and mechanism in simple terms.

1. Prolonged sterile eye irrigation
   Description: Rinsing the eye with sterile saline or balanced salt solution in clinic.
   Purpose: Washes out any remaining toxin and debris.
   Mechanism: Physically dilutes and removes palytoxin from the eye surface, reducing ongoing damage. Anesthesia Key

2. Protective eye shield
   Description: A rigid shield taped over the eye.
   Purpose: Prevents accidental rubbing and further trauma.
   Mechanism: Barrier against external contact so the cornea can start healing.

3. Cold compresses
   Description: Clean, cool compress gently over closed lids.
   Purpose: Eases pain and swelling.
   Mechanism: Vasoconstriction reduces inflammatory fluid and nerve firing.

4. Temporary light avoidance & rest
   Description: Dim room, sunglasses outdoors.
   Purpose: Lessens light sensitivity (photophobia).
   Mechanism: Reduces trigeminal nerve irritation and squinting that can worsen discomfort.

5. Discontinuation of contact lenses
   Description: Stop lens wear until fully healed and cleared by your eye doctor.
   Purpose: Lowers infection risk and friction.
   Mechanism: Eliminates mechanical micro-trauma and biofilm reservoirs.

6. Careful removal of necrotic debris (debridement)
   Description: Doctor gently removes loose, dead epithelium at the slit lamp.
   Purpose: Speeds regrowth of healthy surface cells.
   Mechanism: Removes barriers to epithelial migration and lowers microbial load.

7. Bandage contact lens (BCL) as a device
   Description: A soft, therapeutic lens placed by the clinician.
   Purpose: Pain control and protection.
   Mechanism: Acts like a “skin graft” for the cornea, allowing epithelium to slide and seal; used only with close follow-up and antibiotic coverage. ResearchGate

8. Frequent preservative-free lubrication (if your team prefers to count this as a device/tear substitute rather than a drug)
   Description: Sterile single-use artificial tears/gel.
   Purpose: Comfort and surface healing.
   Mechanism: Dilutes inflammatory mediators and reduces friction with each blink. (Protocols vary.)

9. Punctal occlusion (temporary plugs)
   Description: Doctor places small plugs in tear ducts.
   Purpose: Keeps tears and medications on the eye longer.
   Mechanism: Reduces tear drainage, increasing moisture and contact time.

10. Pressure-relieving measures for high IOP (non-drug)
    Description: Gentle avoidance of Valsalva (straining), no tight collars.
    Purpose: Helps keep eye pressure lower.
    Mechanism: Reduces venous back-pressure that can raise IOP.

11. Nutritional hydration plan
    Description: Scheduled water intake and balanced meals.
    Purpose: Supports tissue repair.
    Mechanism: Adequate systemic hydration and micronutrients aid collagen and epithelial growth (adjunctive; not a cure).

12. Sleep optimization
    Description: Early bedtime, humidified room if dry.
    Purpose: Nighttime healing.
    Mechanism: During sleep, epithelial turnover and tear film stability improve.

13. Humidifier & blink breaks
    Description: Indoor humidity ~40–50%; regular blink rests from screens.
    Purpose: Reduces dryness and irritation.
    Mechanism: Slows tear evaporation, stabilizing the surface.

14. Education on coral safety
    Description: Written safety instructions for reef tank owners.
    Purpose: Prevents repeat exposures.
    Mechanism: Teaches PPE use (gloves, eye protection), no boiling rocks, good ventilation. CDCSA Health

15. Household exposure control
    Description: Keep coral work outdoors or in well-ventilated areas; keep children/pets away.
    Purpose: Prevents family exposure.
    Mechanism: Dilution and isolation of airborne droplets/fumes. CDC

16. Sunglasses with UV protection
    Description: Wraparound shades.
    Purpose: Comfort and reduces photophobia.
    Mechanism: Blocks UV/visible glare, decreasing nerve stimulation.

17. Avoid topical anesthetic use at home
    Description: Do not use leftover “numbing drops.”
    Purpose: Prevents severe corneal toxicity and delayed healing.
    Mechanism: Home anesthetic use blocks corneal healing and masks worsening—strictly clinic-use only.

18. Allergen and irritant avoidance
    Description: Pause eye makeup, sprays, and chlorinated pools during healing.
    Purpose: Prevents additive irritation.
    Mechanism: Reduces chemical load on the recovering epithelium.

19. Safe pain-coping strategies
    Description: Guided breathing/relaxation to limit squeezing the eyelids.
    Purpose: Comfort without eye rubbing.
    Mechanism: Lowers muscle clenching that worsens discomfort.

20. Close, scheduled follow-up
    Description: Frequent rechecks early on.
    Purpose: Catches pressure spikes, infections, or melts quickly.
    Mechanism: Early detection of complications improves outcomes. EyeWiki

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Drug treatments

Doses are typical adult ranges used by ophthalmologists; your doctor will tailor them to your eye, medical history, and local guidelines.

1. Topical fluoroquinolone antibiotic (e.g., moxifloxacin 0.5%)
   Class: Broad-spectrum antibiotic eye drop.
   Dose/Timing: 1 drop every 1–2 hours while awake for the first day, then 4–6×/day; adjusted as the surface closes.
   Purpose: Prevents or treats secondary bacterial infection over the damaged cornea.
   Mechanism: Inhibits bacterial DNA enzymes (DNA gyrase/topoisomerase).
   Side effects: Mild burning, rare allergy. HCA Healthcare Scholarly CommonsAAO

2. Topical corticosteroid (e.g., prednisolone acetate 1%)
   Class: Anti-inflammatory steroid eye drop.
   Dose/Timing: Often every 2–6 hours, then taper over days–weeks under close monitoring.
   Purpose: Tames toxin-driven inflammation that can cause scarring and ring infiltrates.
   Mechanism: Blocks inflammatory gene expression and immune cell activity.
   Side effects: Raised eye pressure, delayed healing/infection risk—requires close follow-up; typically used with antibiotic cover. Anesthesia KeyAAO

3. Cycloplegic/mydriatic (e.g., atropine 1% bid or cyclopentolate 1% tid)
   Class: Antimuscarinic eye drop.
   Purpose: Relieves ciliary spasm (deep aching pain) and prevents iris-lens sticking (synechiae).
   Mechanism: Temporarily paralyzes the focusing muscle and dilates the pupil.
   Side effects: Blurry near vision, light sensitivity. EyeWiki

4. Oral doxycycline (100 mg twice daily)
   Class: Tetracycline antibiotic with anti-collagenase action.
   Purpose: Protects corneal collagen and reduces the risk of corneal “melt.”
   Mechanism: Inhibits matrix metalloproteinases (MMPs) and inflammation; antibacterial if infection co-exists.
   Side effects: Photosensitivity, stomach upset; avoid in pregnancy/children. ResearchGate

5. Oral vitamin C/ascorbic acid (500–1000 mg, 1–2×/day)
   Class: Vitamin/antioxidant.
   Purpose: Supports collagen cross-linking and corneal wound repair.
   Mechanism: Cofactor for collagen enzymes; scavenges oxidative stress from toxin injury.
   Side effects: GI upset at high doses; adjust for renal stone risk. ResearchGate

6. Intraocular pressure (IOP)–lowering drops (e.g., timolol 0.5% bid; brimonidine 0.2% tid; dorzolamide 2% tid; plus oral acetazolamide 250 mg q6–8h if needed)
   Class: Beta-blocker, alpha-agonist, carbonic anhydrase inhibitor.
   Purpose: Treats pressure spikes from inflammation or steroid response.
   Mechanism: Reduces aqueous production or increases outflow.
   Side effects: Timolol—wheezing/bradycardia risk; brimonidine—drowsiness; CAIs—metallic taste, tingling; acetazolamide—paresthesias, metabolic acidosis (avoid in sulfa allergy). EyeWiki

7. Preservative-free lubricants and gel/ointment at night
   Class: Tear substitutes/ocular surface protectants.
   Purpose: Comfort and better epithelial migration.
   Mechanism: Stabilizes tear film and reduces shear stress.
   Side effects: Temporary blur after ointments. EyeWiki

8. Systemic corticosteroid (selected cases)
   Class: Anti-inflammatory steroid by mouth/IV (e.g., short course dexamethasone or prednisone per specialist).
   Purpose: For severe inflammatory response and systemic symptoms after significant exposure, under physician supervision.
   Mechanism: Systemic immune modulation.
   Side effects: Gastric upset, glucose elevation, mood/insomnia, infection risk; only when benefits outweigh risks. HCA Healthcare Scholarly Commons

9. Empiric antiviral in atypical cases (e.g., valacyclovir) (case-by-case)
   Class: Antiviral nucleoside analog.
   Purpose: Occasionally used early if the picture may mimic herpetic keratitis; stopped if not needed.
   Mechanism: Inhibits viral DNA polymerase (not a toxin antidote).
   Side effects: Headache, GI upset; adjust in kidney disease. ResearchGate

10. Topical N-acetylcysteine 5–10% (off-label)
    Class: Mucolytic antioxidant.
    Purpose: For filamentary keratitis or stubborn mucus strands during recovery.
    Mechanism: Breaks disulfide bonds in mucus; antioxidant effects may help surface comfort.
    Side effects: Temporary stinging; pharmacy-compounded.

Important: Treatment plans differ by case; your ophthalmologist will decide the right combination and taper. There is no specific antidote to palytoxin. Early irrigation + antibiotic cover + controlled steroids + cycloplegia and careful follow-up are the usual backbone. PubMedAAO

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Dietary molecular supplements

These do not neutralize palytoxin and should never delay medical care. Discuss with your clinician, especially if pregnant, on blood thinners, or with kidney/liver issues.

1. Vitamin C (ascorbic acid) — 500–1000 mg/day
   Supports collagen cross-linking and antioxidant defense during corneal repair (see drug section). ResearchGate

2. Omega-3 fatty acids (EPA/DHA) — ~1–2 g/day combined EPA+DHA
   May reduce ocular surface inflammation and improve tear stability in dry-eye-like recovery phases.

3. Vitamin A (dietary, not mega-dosing) — max 2500–3000 IU/day from diet; avoid high-dose supplements
   Needed for epithelial health and tear film—prefer food sources (eggs, leafy greens). Avoid high doses and avoid in pregnancy.

4. Zinc — 8–11 mg/day total intake (diet ± low-dose supplement)
   Cofactor for many enzymes in wound healing; keep within RDA to avoid copper deficiency.

5. Lutein/Zeaxanthin — 10–20 mg lutein + 2–4 mg zeaxanthin/day
   Antioxidants that may help ocular oxidative stress; evidence extrapolated from retina health.

6. Vitamin D — check and correct deficiency per clinician
   Immune-modulating effects may support balanced inflammation.

7. N-acetylcysteine (oral) — 600 mg 1–2×/day
   Systemic antioxidant precursor; sometimes used for mucus/filaments; discuss interactions.

8. Curcumin (with piperine for absorption) — 500–1000 mg/day extract
   Plant-based anti-inflammatory; avoid with anticoagulants unless cleared.

9. Quercetin — 500 mg/day
   Flavonoid with antioxidant actions; human ocular evidence limited.

10. Coenzyme Q10 — 100–200 mg/day
    Cellular mitochondrial cofactor; theoretical benefit during tissue repair.

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Regenerative / stem-cell–related” therapies

There are no approved stem-cell drugs specifically for palytoxin keratitis. A few regenerative ocular surface options may be considered case-by-case, often off-label:

1. Autologous serum tears (20–50%)
   Dose: 4–8×/day (prepared from your own blood in a sterile lab).
   Function/Mechanism: Provides epithelial growth factors, vitamins (including vitamin A), and anti-inflammatory proteins that can speed corneal healing in non-healing defects.

2. Platelet-rich plasma (PRP) / platelet lysate eye drops
   Dose: Variable (often 4–8×/day).
   Function/Mechanism: High platelet growth factors (PDGF, TGF-β) that stimulate epithelial repair; used in refractory surface disease.

3. Cenegermin (recombinant human nerve growth factor) 0.002%
   Dose: 1 drop 6×/day for 8 weeks (approved for neurotrophic keratitis).
   Function/Mechanism: Restores corneal nerve health and epithelial integrity; in palytoxin, may be considered off-label if the cornea becomes neurotrophic (numb). (Decision is specialist-level.)

4. Amniotic membrane (biologic; see surgery below)
   Dose: Placed as a graft or as a cryopreserved inlay (Prokera-type).
   Function/Mechanism: Delivers anti-inflammatory cytokines and a basement-membrane scaffold that promotes epithelial migration.

5. RGTA® (matrix-mimetic polymers; where available)
   Dose: Drops 1–4×/day (country-dependent, off-label).
   Function/Mechanism: Protects heparan-sulfate binding sites in the extracellular matrix, helping cells attach and heal.

6. Topical insulin (dilute, compounded; experimental)
   Dose: e.g., 1 unit/mL, several times daily in non-healing epithelial defects.
   Function/Mechanism: Epithelial trophic effect via IGF/insulin pathways.
   (Discuss benefits/risks with your cornea specialist; evidence in toxin keratitis is limited.)

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Surgeries and procedures

1. Amniotic membrane transplantation (AMT)
   Procedure: A thin biologic membrane is sutured or placed on the cornea (or delivered with a ring device).
   Why: Calms inflammation, relieves pain, and jump-starts epithelial healing in non-healing defects or deep ulcers; may reduce scarring. PubMed

2. Superficial keratectomy / epithelial debridement
   Procedure: The surgeon removes dead surface tissue and smooths irregular stroma.
   Why: Removes toxic/necrotic layers and promotes a healthy epithelial sheet to grow.

3. Tissue adhesive (cyanoacrylate) + bandage lens
   Procedure: A tiny amount of glue seals a small corneal perforation, then a BCL is placed.
   Why: Emergency sealing of micro-perforations to maintain eye integrity while healing.

4. Conjunctival (Gundersen) flap
   Procedure: A flap of conjunctiva is rotated to cover a stubborn, non-healing corneal surface.
   Why: Provides blood supply and protection when other treatments fail.

5. Keratoplasty (corneal transplant: lamellar or penetrating)
   Procedure: Replaces diseased corneal layers with donor tissue.
   Why: For dense scarring, thinning, or perforation not fixable by other means; reserved for the end of the road with careful timing. AAO

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Prevention tips

1. Wear wraparound eye protection any time you handle or cut corals.

2. Use gloves; avoid touching your face/eyes.

3. Never heat or boil coral or live rock—this can release dangerous fumes.

4. Work in a well-ventilated area or outdoors; use fans or fume extraction.

5. Label and secure tanks with zoanthids/palythoa; keep kids and pets away.

6. Use tools/tongs instead of fingers; avoid squeezing polyps.

7. Wash hands and tools thoroughly after handling corals.

8. Discard wastewater safely; don’t splash.

9. Do not wear contact lenses during coral work.

10. Educate household members about palytoxin and what to do if exposure occurs. CDCSA Health

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When to see a doctor

• Immediately (same day) if you have eye pain, redness, light sensitivity, or vision change after coral or aquarium work—even if you already rinsed your eye. Ask to see an ophthalmologist (eye MD) and mention zoanthid/palytoxin.

• Urgently if anyone in the home has fever, cough, shortness of breath, chest tightness, metal/bitter taste, or fatigue after coral cleaning—these can be systemic exposure signs. CDC

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What to eat and what to avoid during recovery

Food cannot neutralize palytoxin, but smart nutrition supports healing.

• Eat:

1. Hydration first—regular water intake.

2. Vitamin-C–rich foods: citrus, kiwi, guava, peppers.

3. Leafy greens & orange vegetables (vitamin A precursors): spinach, kale, carrots, sweet potatoes.

4. Omega-3 sources: fatty fish (salmon, sardines) or plant sources (chia, flax).

5. Eggs and dairy (if tolerated) for vitamin A and protein.

6. Nuts/Seeds (zinc, vitamin E).

7. Lean proteins (amino acids for collagen repair).

8. Whole grains/legumes (steady energy for healing).

9. Colorful fruits/berries (antioxidants).

10. Warm soups/broths (comfort, hydration).

• Avoid/limit:

1. Alcohol (dehydrates and can disrupt sleep).

2. Smoking or vaping (slows healing, worsens inflammation).

3. Ultra-processed/high-sugar foods (may promote inflammation).

4. Very spicy/irritating steam near eyes while still sensitive.

5. High-dose vitamin A supplements (risk of toxicity); prefer foods unless clinician prescribes.

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FAQs

1) What exactly is palytoxin?
A natural poison from some zoanthid/palythoa corals and related marine life. It can harm eyes, skin, and lungs. NCBI

2) How do people get palytoxin keratitis?
Usually by splash during coral handling or aerosol/fumes when coral/live rock is heated or scrubbed; sometimes by touching the eye with contaminated fingers. CDCCORAL Magazine

3) Is there an antidote?
No. Treatment focuses on rapid irrigation, infection prevention, and controlled inflammation. PubMed

4) How soon should I rinse my eye?
Immediately—the sooner the better. Keep rinsing for a long time (15–20 minutes) and seek urgent care. CDC

5) Why do doctors sometimes use steroids if steroids can slow healing?
In toxin injuries, inflammation itself can scar the cornea. Doctors balance risk/benefit, often combining antibiotics + careful steroid tapers with close monitoring of pressure and healing. Anesthesia KeyAAO

6) Will I need antibiotics even if it isn’t an infection?
Yes, often—because the damaged surface is vulnerable to bacteria until it closes; antibiotics reduce that risk. AAO

7) How long until vision improves?
Varies. Mild cases may improve in days to weeks; severe ulcers may need weeks to months and sometimes surgery. Earlier treatment usually means a better outlook. PubMed

8) Can this be mistaken for other eye problems?
Yes—infectious keratitis, Acanthamoeba, chemical burns, or autoimmune keratitis can look similar. Aquarium/coral exposure history is the key clue. IOVS

9) Is it contagious?
No. The toxin is the problem, not a germ. Family members are only at risk from the same environmental exposure.

10) Do I need to stop contact lenses?
Yes—stop immediately and don’t restart until your ophthalmologist says it’s safe.

11) Could eye pressure go up?
Yes—either from inflammation or steroid response—so doctors often check IOP at follow-ups. EyeWiki

12) Can fumes make people sick even without an eye splash?
Yes. Heating/boiling corals can release aerosols that cause systemic symptoms (fever, cough, chest tightness). Get medical help if this happens. CDC

13) Are amniotic membranes really helpful?
They can be very helpful in stubborn or deep injuries by reducing inflammation and providing a healing scaffold. PubMed

14) Should I keep working on my reef tank while I’m healing?
No. Avoid coral handling until fully recovered—and use PPE carefully next time.

15) What should I tell the ER or clinic?
Say you were handling zoanthid/palythoa coral and are worried about palytoxin exposure. This speeds correct treatment. EyeWiki

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The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 19, 2025.