Ocular Effects of Sulfur Mustard and Therapeutic Approaches

Abstract

Sulfur mustard (SM) is a strong blistering, highly reactive, lipophilic chemical war agent that causes injury in different organs including the skin, eyes, and respiratory tract. The Eyes are especially susceptible to the consequences of SM poisoning because of the aqueous and mucosal nature of conjunctiva and cornea. DNA alkylation and depletion of glutathione, are the most important mechanisms of SM action in the eye injuries. Acute clinical symptoms are including decrease in visual acuity, dryness, photophobia, blepharospasm, conjunctivitis, and complaints of foreign body sensation and soreness that gradually progress to severe ocular pain. Corneal abrasions, ulcerations, vesication, and perforations are common corneal consequences in SM injured victims. Appearance of chronic symptoms has been reported as chronic inflammation of the corneal and conjunctival vasculature, ischemia, lipid and cholesterol deposition, scarring in cornea, corneal thinning, opacification and perforation of the cornea, limbal stem cell deficiency (LSCD), and neovascularization. Different medical and surgical protocols have been documented in the management of SM-induced ocular injuries, including preservative-free artificial tears, topical steroids and antibiotic, mydriatic, antiglaucoma drops, therapeutic contact lenses, dark glasses and punctal plugs/cauterization, N-acetylcysteine, tarsorrhaphy, amniotic membrane transplantation, stem cell transplantation, and corneal transplantation. New drugs such as resolvin E1, topical form of essential fatty acids, thymosin β4, 43 amino-acid polypeptides, topical form of curcumin, newly formulated artificial tears, diquafosol, rebamipide, tretinoin, and oral uridineseems to be beneficial in the management of ocular lesion associated with sulfur mustard poisoning. Further studies are needed to approve these drugs in SM victims. J. Cell. Biochem. 118: 3549-3560, 2017. © 2017 Wiley Periodicals, Inc.

A review on symptoms, treatments protocols, and proteomic profile in sulfur mustard‐exposed victims

“…Management of delayed ocular symptoms is medical and surgical. These treatments are artificial tears and lubricants, anti‐inflammatory drugs, immunomodulatory drugs, human blood‐derived therapy, amniotic membrane transplantation, tarsorrhaphy, stem cell transplantationand corneal transplantation …”

Nitrogen mustard-induced corneal injury involves the sphingomyelin-ceramide pathway

“…Sulfur mustard (SM, bis [2-chloroethyl]sulfide) is a potent, highly reactive, lipophilic vesicant [1][2][3]. It is highly volatile at room temperature and, due to its lipophilicity, is a very persistent contaminant of the environment, especially of the soil [4].…”

Clinical practice guidelines for prevention, diagnosis and management of early and delayed-onset ocular injuries due to mustard gas exposure

“…At this time, there is no cure for SM chronic and delayed keratitis caused by and medications are mostly used as a palliative treatment. [ 33 34 ] On the other hand, there are still new cases of delayed-onset keratitis due to MG exposure after many years have passed since the exposure and there is a possibility of using MG weapons in the future. Therefore, the evidence-based clinical practice guidelines (CPGs) for prevention, diagnosis, treatment and follow-up of early and late eye injuries due to MG were developed by the Knowledge Management Unit (KMU) of the Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences under the supervision of the Office for Healthcare Standards, Deputy of Curative Affairs, Iran Ministry of Health and Medical Education.…”