Corneal Blindness Caused by Mustard Gas

Abstract

Mustard gas is a lipophilic, highly cytotoxic agent that rapidly penetrates tissue, and the eye is one of the organs mostly affected. Mustard gas-related ocular injuries can be divided into immediate, chronic, and delayed-onset phases. Late complications, developing after 1-40 years, can cause progressive and permanent reduction in visual acuity and even blindness. A wide range of late ocular involvements have been reported, which include chronic blepharitis, limbal ischemia and stem cell deficiency, and corneal scarring and neovascularization. The majority of corneal involvements are limited to the anterior stroma, leaving the posterior stroma and endothelium relatively intact. Therefore, lamellar keratoplasty is appropriate for the management of corneal involvements in the majority of victims. This procedure can be performed alone or in combination with limbal stem cell transplantation.Mustard gas-related ocular injuries can be divided into immediate, chronic, and delayedonset phases [12]. Acute manifestations of varying degrees, including eyelid erythema and edema, chemosis, subconjunctival hemorrhage, epithelial edema, punctate erosions, and corneal epithelial defects, develop in 75-90% of exposed individuals and can follow three different courses: complete resolution, persistent smoldering inflammation (chronic form), or reappearance of lesions after a latent period of quiescence (delayed form) [13,14].Late complications, developing after 1-40 years, can cause progressive and permanent reduction in visual acuity and even blindness, and they occur in approximately 0.5% of those initially