Abstract
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