Delayed Mustard Gas Keratitis: Clinical Course and In Vivo Confocal Microscopy Findings

Abstract

Purpose:To report the detailed clinical and in-vivo confocal microscopic findings in a patient with delayed-onset mustard gas keratitis observed 20 years after initial exposure. Methods:Case report. A 38-year-old man who was exposed to mustard gas in Iraq at the age of 19 was examined after presenting with ocular symptoms 17 years after initial recovery from the exposure. Slit-lamp biomicroscopy, corneal topography and in-vivo confocal microscopy was performed on both corneas. Results:The clinical symptoms were consistent with a delayed-form of mustard gas keratitis, although the patient had clear central corneas and good visual acuity. Confocal microscopic findings included evidence of epithelial abnormalities, necrotic changes in the anterior stroma, subbasal and anterior stromal nerve proliferation, and deep stromal keratocyte activation. Conclusions:In-vivo confocal microscopy revealed persistent morphologic abnormalities in the anterior stroma of both corneas 20 years after initial exposure to mustard gas. The detection of a population of dendritic cell bodies in the central epithelium and evidence of keratocyte activation and migration in the deep stroma indicated the presence of ongoing sub-clinical processes.

Structural, Morphological, and Functional Correlates of Corneal Endothelial Toxicity Following Corneal Exposure to Sulfur Mustard Vapor

“…Although analysis has been severely limited by the poor structural integrity of MGK corneas, histology and IVM have indicated an endothelial component to the SM injury. 22,33,34 Establishing a causal relationship between corneal pathologies and SM exposure is further complicated by the fact that human casualties are decades beyond the point of exposure. Nonetheless, the possibility of an endothelial contribution to corneal pathogenesis has important implications for SM therapeutic research.…”

Long Term Ocular Effects of Mustard Gas Poisoning: A Cross-Sectional Study in Iraqi Kurdish Civilians

“…In the later stages, inflammatory infiltration of connective tissue and exudation are present. The injury due to persistent morphologic abnormalities is limited to the anterior segment of the eye [12,13]. In our study, the symptomatology of ocular disease was different compared with Iranian victims exposed to chemical agents during the Iran-Iraq war.…”

Corneal Blindness Caused by Mustard Gas

“…severely wounded [6,13]. A wide range of late ocular involvements have been reported, which include chronic blepharitis, dry eye, conjunctival vessel tortuosity, limbal ischemia and stem cell deficiency, corneal scarring and neovascularization, corneal thinning and perforation, epithelial irregularity, recurrent or persistent epithelial defects, and secondary degenerative changes including lipid/amyloid deposits (Figure 1) [5,6,[12][13][14][15][16][17].…”