Quality of life in chemical warfare survivors with ophthalmologic injuries: the first results form Iran Chemical Warfare Victims Health Assessment Study

Abstract

Background: Iraq used chemical weapons extensively against the Iranians during the Iran-Iraq war (1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988). The aim of this study was to assess the health related quality of life (HRQOL) in people who had ophthalmologic complications due to the sulfur mustard gas exposure during the war.

Vision-Related Quality of Life in Patients with Ocular Chemical Burns

“…Therefore, the traditional objective examinations to measure the clinical outcome in ophthalmology, for instance visual acuity, are inadequate in assessing a broad array of outcomes, such as physical function, social function, and overall health. However, until now, only one study focusing on health-related quality of life (QOL) in chemical warfare victims with ophthalmologic complications has been published, 8 and no studies have been performed to specifically determine the vision-related QOL in persons with ocular chemical injury.…”

Ocular Toxicity of Chemical Warfare Agents

“…While 60.7% of survivors had no ocular symptoms, 35% were classified as having mild symptoms, involving persistent conjunctival irritation; 3.6% as having moderate symptoms, involving corneal opacities, mild corneal edema, and band keratopathy; and 0.7% as having severe symptoms, which included corneal melting and neovascularization. In a separate, nonoverlapping study involving 134 patients examined 17-22 years after exposure, 83% of survivors presented with ocular complications, which included burning (69%), photophobia (64%), blepharitis (28%), tearing (12%), corneal ulceration (12%), and retinal and conjunctival complications (4.5%) (Namazi et al, 2009). In another study specifically evaluating ocular injury in 40 veterans from 16-20 years after a single, highdose exposure, 39 reported persistent ocular sequelae, including chronic conjunctivitis (17.5%), corneal thinning (15%), limbal ischemia (12.5%), corneal opacity (10%), corneal vascularization (7.5%), and corneal epithelial defects (5%) .…”

“…The latter two trajectories are collectively referred to as MGK. Although the relationship between the chronic and delayed-onset forms of MGK is unclear, the severe form of each involves an idiotypic, noninfectious keratitis with secondary keratopathies such as persistent epithelial lesions, corneal neovascularization, and progressive corneal degeneration (Khateri et al, 2003;Mousavi et al, 2009). Since both the chronic and delayed-onset forms of MGK result from a severe corneal exposure and share similar symptoms, it may be that a common etiology is involved, despite temporal differences in clinical onset.…”

“…According to these studies and many others, the delayed HD injury is usually progressive and difficult to clinically manage (Safarinejad et al, 2001). Not surprisingly, chemical warfare survivors with ophthalmologic complications suffer from a significantly lower quality of life as a consequence of their chronic injuries (Mousavi et al, 2009). …”

Shift of oxidants and antioxidants levels in rats as a reaction to exposure to sulfur mustard

“…It has been used as a chemical warfare agent since World War I (Evison et al, 2002). The recent example of widescale sulfur mustard application is during the Iran-Iraq war in 1980-1988. After the war, victims suff ered from typical health disorders that are still persisting (Mousavi et al, 2009). The production, stockpiling and use of chemical weapons is strictly regulated by the 'Convention on the Prohibition of the Development, Production, Stockpiling and use of Chemical Weapons and on their Destruction' signed on 13 January 1993.…”