Long-term ocular consequences of sulfur mustard in seriously eye-injured war veterans.
BACKGROUND
Sulfur mustard (SM) has been used as a dangerous chemical warfare agent since the early 20th century. Although many descriptive studies about SM-induced ocular injuries are present in the medical literature, few of them have been conducted over a large group with serious ocular involvement.


METHODS
This descriptive study was conducted on 149 severe SM-intoxicated war veterans. Ocular history, anterior and posterior segment findings using a slit lamp, and direct and indirect ophthalmoscopic findings were recorded. Severity of the disease was also recorded based on a chart of the Foundation of Martyrs and Veterans Affairs.


RESULTS
Ocular complains included photophobia (73.2%), sense of decreased vision (72.5%), dry eye sensation (66.4%), foreign body sensation (61.1%), tearing (46.3%), and pain (43.0%). Slit lamp findings were meibomian gland dysfunction (MGD; 96%), blepharitis, punctal closure, trichiasis, tear break-up time, and tear meniscus layer abnormality (80% to 90%). Conjunctival disturbances included vascular abnormality, ischemia, hyperemia, subconjunctival fibrosis, and pterygium. Limbal changes were abnormal vessels, limbal tissue loss and pigment loss, and pannus formation. Corneal problems included epithelial and stromal disturbances, calcium deposition, and melting. The most frequent previous surgeries were punctal closure, lamellar keratoplasty (LK), and stem cell allograft. Severity of intoxication included mild (17%), moderate (25%), and severe (57%).


CONCLUSIONS
Chronic blepharitis and decreased tear secretion are the 2 most important and influencing factors in progression of ocular problems in SM injuries. The more severe the initial exposure, percentage of disability, and duration of ocular involvement, the higher the likelihood of mustard gas keratopathy.
Ghasemi
Hassan
H
Department of Ophthalmology, Shahed University, Tehran, Iran.
Ghazanfari
Tooba
T
Ghassemi-Broumand
Mohammad
M
Javadi
Mohammad Ali
MA
Babaei
Mahmoud
M
Soroush
Mohammad Reza
MR
Yaraee
Roya
R
Faghihzadeh
Soghrat
S
Poorfarzam
Shahriar
S
Owlia
Parviz
P
Naghizadeh
Mohammad Mehdi
MM
Etezad-Razavi
Mohammad
M
Jadidi
Khosro
K
Naderi
Mostafa
M
Hassan
Zuhair Mohammad
ZM
D000328:Adult; D002057:Burns, Chemical / Q000175:diagnosis / Q000209:etiology*; D002619:Chemical Warfare Agents / Q000633:toxicity*; D004185:Disability Evaluation; D005126:Eye Burns / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D007492:Iran; D009151:Mustard Gas / Q000633:toxicity*; D013997:Time Factors; D015599:Trauma Severity Indices; D014728:Veterans; D014729:Veterans Disability Claims; D014792:Visual Acuity; D014857:Warfare
D002619:Chemical Warfare Agents; D009151:Mustard Gas