April 2010
Volume 51, Issue 13
ARVO Annual Meeting Abstract  |   April 2010
Delayed Mustard Keratitis in Northern Iraq
Author Affiliations & Notes
  • K. Baban
    Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin
  • A. H. Friedman
    Department of Ophthalmology, Mount Sinai School of Medicine, New York, New York
  • L. M. Said
    Chwarbax Eye Hospital, Sulaimaniya, Iraq
  • Footnotes
    Commercial Relationships  K. Baban, None; A.H. Friedman, None; L.M. Said, None.
  • Footnotes
    Support  Doris Duke Clinical Research Fellowship; Rosenbluth Foundation Travel Grant
Investigative Ophthalmology & Visual Science April 2010, Vol.51, 5355. doi:
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    • Get Citation

      K. Baban, A. H. Friedman, L. M. Said; Delayed Mustard Keratitis in Northern Iraq. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5355.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: : To describe signs and symptoms of corneal damage 18 years following exposure to a chemical weapons cocktail believed to consist of mustard gas, organophosphates, and nerve agents.

Methods: : Case series including history, biomicroscopy, and retrospective chart review of 18 patients (36 eyes) drawn from the Halabja City Hospital Ophthalmology Clinic in Halabja, northern Iraq over a 2 month period.

Results: : Eighteen of 18 patients demonstrate a bilateral, triphasic condition characterized by: (A) acute onset blindness at time of initial exposure lasting 1-2 months, followed by (B) a period of complete resolution lasting years, and (C) onset of progressive recurrent symptoms an average of 15 years following initial exposure. Three of 18 patients (16.7%) had undergone bilateral penetrating keratoplasty, and one (5.6%) required unilateral enucleation for corneal perforation. Eighteen (62.1%) of 29 eyes demonstrated BCVA worse than 20/200; 18 (62.1%) corneal opacities; 21 (72.4%) corneal ulcers; 24 (82.8%) conjunctival injection and chemosis, 29 (100%) photosensitivity, and 6 (20.7%) limited extraocular motility. All cases have been unresponsive to medical treatment.

Conclusions: : History and exam findings are largely consistent with Delayed Mustard Keratitis (DMK) following exposure to highly concentrated mustard gas. Atypical findings--such as immediate onset of symptoms, initial severe visual impairment persisting 1-2 months, limitation of extraocular motility, and apparent predilection for young adults--may represent a broader spectrum of DMK than has been previously appreciated, or indicate possible synergistic effect of chemical agents used and warrants further investigation.

Keywords: keratitis • transplantation • clinical (human) or epidemiologic studies: natural history 

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