Mustard Gas-Induced Ocular Surface Disorders: An Update on the Pathogenesis, Clinical Manifestations, and Management Publisher Pubmed



Soleimani M^{1, 2} ; Momenaei B² ; Baradaranrafii A^{3, 4} ; Cheraqpour K² ; An S¹ ; Ashraf MJ¹ ; Abedi F¹ ; Javadi MA³ ; Djalilian AR¹
Source: Cornea Published:2023

Abstract

Purpose:Mustard gas (MG) is a potent blistering and alkylating agent that has been used for military and terrorism purposes. Ocular surface injuries are common after exposure to MG. This review provides an update on the pathophysiology, ocular surface complications, and treatment options for MG-related ocular injuries.Methods:Required information was obtained by reviewing various databases such as Cochrane Library, Google Scholar, and PubMed until March 2022. Data were collected by using keywords: mustard gas OR sulfur mustard AND eye OR cornea OR ocular complication OR keratitis OR keratopathy OR limbal stem cell deficiency OR dry eye.Results:Chronic intracellular toxicity, inflammation, and ischemia have been shown to play an essential role in the pathogenesis of MG injury. Ocular surface injuries can have acute, chronic, and most distinctly a delayed-onset presentation leading to various degrees of limbal stem cell deficiency. To date, no treatment has been agreed on as the standard treatment for chronic/delayed-onset MG keratopathy. Based on the authors' experience, we propose a management algorithm for MG-related ocular surface injuries involving optimization of ocular health, anti-inflammatory therapy, and if needed surgical interventions. The management of chronic and delayed-onset presentation remains challenging.Conclusions:MG keratopathy is a unique form of chemical injury which can lead to a range of ocular surface pathologies. Long-term anti-inflammatory therapy even in patients with seemingly mild disease may potentially reduce the likelihood of the development of more severe delayed-onset disease. © 2023 Lippincott Williams and Wilkins. All rights reserved.