Staphylococcal exotoxins in ocular infection with focus on enterotoxins

Staphylococcus aureus (S. aureus) is one of principal etiological agents of bacterial keratitis, a blinding corneal infection. Traditional treatment strategies rely heavily on antibiotics. However, the overuse and injudicious use of these agents have significantly contributed to the emergence of multidrug-resistant bacterial strains. Therefore, understanding the role of virulence factors in the disease is important for the design of new therapeutics. This review aims to explore and summarize current research on the role of Staphylococcal toxins, especially enterotoxins (SEs), in ocular infections. The relationship between SEs and ocular infections is reviewed, as are their genomic location and regulatory mechanisms. Current research suggests that SE genes are detected in ocular isolates, with a higher frequency of specific SE genes observed in ocular isolates compared to non-ocular isolates. Additionally, several SE genes have been confirmed to confer cytotoxicity and invasion ability to S. aureus in animal keratitis models. Despite the progress in this area, significant knowledge gaps remain, particularly regarding the specific functions of SEs and the host response pathways. Addressing these questions may contribute to the development of effective preventive and therapeutic measures for eye damage caused by SEs.