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Coral reefs are declining in the Caribbean region due to a variety of reasons. Nitrogen from agriculture, sewage, and other anthropogenic sources is polluting coastal waterways and represents one major threat to reef health. The effect of nitrogen eutrophication on coral reefs was investigated in this review. Nitrogen pollution slows calcification, changes photopigment concentrations, accelerates coral disease rates, increases coral-algal competition, and reduces coral reproduction and recruitment. To conserve these important ecosystems and sustain the variety of services they provide, nitrogen loading to coral reef ecosystems must be reduced.