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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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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.
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.
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.
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.
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