day and covered with a thin layer of nonsensitizing antiseptic ointment, such as mupirocin. A jellyfish sting to
the cornea may cause a foreign body sensation, photophobia, and decreased or hazy vision. Ophthalmologic
examination reveals hyperemic sclera, chemosis, and irregularity of the corneal epithelium with stromal
edema. Depending on the extent of the wound, the anterior chamber may demonstrate the inflammatory
response of iridocyclitis (flare with or without cells). The victim should be referred to an ophthalmologist,
who may prescribe steroid-containing eye medications such as prednisolone acetate 1% with hyoscine 0.25%.
Applying a traditional skin detoxicant directly to the cornea is not recommended, since it is likely to worsen
the tissue injury.
Delayed Reaction. A delayed reaction, similar in appearance to erythema nodosum, may be noted in areas of
skin contact, and be accompanied by fever, weakness, arthralgias, painful joint swelling, and effusions. This
may recur multiple times over the course of 1 to 2 months. The treatment is a 10- to 14-day taper of
prednisone, starting with 50 to 100 mg. Prednisone administration may need to be prolonged or repeated with
each flare of the reaction.
Persistent Hyperpigmentation. Postinflammatory hyperpigmentation is common after the stings of
many jellyfish and other lesser coelenterates. A solution of 1.8% hydroquinone in a glycol and alcohol base
(70% ethyl alcohol and propylene glycol mixed at a 3:2 ratio) twice a day as a topical agent for 3 to 5 weeks
has been used successfully to treat hyperpigmentation after a Pelagia noctiluca sting.
Persistent Cutaneous Hypersensitivity. Persistent local dermal hypersensitivity may occur after a
jellyfish sting, such as that from the Hawaiian box jellyfish Carybdea alata. This is characterized by
eythematous papulonodular lesions in the pattern of the original sting, which may persist for months.
Treatment, which may be unsatisfactory, consists of topical and intralesional steroids.
Prevention
A protocol has been developed to establish the effectiveness of topical agents to block firing of
nematocysts. Current research is directed at a combination jellyfish sting inhibitor-sunscreen lotion (Safe Sea:
www.nidaria.com) that may prevent discharge of more than 90% of nematocysts that contact protected skin.
Failed topical barriers include petrolatum, mineral oil, silicone ointment, cocoa butter, and mechanic's grease.
If jellyfish are sighted, they should be given a wide berth because the tentacles may trail great distances from
the body. All swimmers and divers in hazardous areas should be on constant alert. Persons should not dive
headfirst into jellyfish-infested waters; it is far safer to walk in. Bathers should wear protective clothing in
infested areas. This includes "stinger suits" or a double thickness of panty hose. If "stinger enclosures" are
present, bathers should stay within the netted barriers.
Divers concerned about jellyfish tentacles dangling from the surface or congregations of creatures at the
surface should remain deeper than 20 feet and should always check snorkel and regulator mouthpieces for
tentacle fragments prior to entering the water in endemic areas. In areas inhabited by anemones and hydroid
corals, protective gloves should be worn when handling specimens. Beached dead jellyfish or tentacle
fragments washed up after a storm can still inflict serious stings. Any person stung by a jellyfish should leave
or be assisted from the water because of the risk of drowning.
The International Consortium for Jellyfish Stings was formed to gather reports and encourage
prospective investigations. At the time of this writing, a marine sting or bite report form can be obtained from
Joseph W. Burnett, M.D., Department of Dermatology, 6th Floor, University of Maryland Hospital, 405 West
Redwood Street, Baltimore, MD 21201-1703.
Hydrozoa
The hydrozoans range in configuration from the feather hydroids and sedentary Millepora hydroid
coral to the free-floating siphonophore Physalia (Portuguese man-of-war). These are perfect examples of the
class Hydrozoa.
Hydroids. Hydroids are the most numerous of the hydrozoans). The feather hydroids of the order
Leptomedusae, typified by Lytocarpus philippinus ("fire weed" or "fire fern"), are featherlike or plumelike
animals that sting the victim who brushes against or handles them. After a storm the branches may be
fragmented and dispersed through the water, so that merely diving or swimming in the vicinity causes itching
and burning and may induce visible skin irritation.
Clinical aspects. Contact with the nematocysts of a feather hydroid induces a mild reaction, which
consists of instantaneous burning, itching, and urticaria. If the exposure is brief, the skin rash may not be
