Systemic and ocular complications of sulfur mustard: A panoramic review

Abstract

This review describes the evaluation of acute and chronic systemic and ocular toxic effects of sulfur mustard (SM) on exposed humans. It is intended to increase the awareness of extensive and dangerous environmental hazards of this agent and describe different treatment modalities for systemic and ocular involvement. Historical information and current events were accessed through the internal and external military field manuals and Internet searches. We reviewed the history, mechanism of action, and clinical and treatment modalities relating to ocular involvement of SM poisoning, by accident, terrorism, or war exposure. SM is the most dangerous organochlorine vesicant agent, which alkylates DNA. In liquid or gas form, its main targets are the eyes, skin, and lungs. Clinical effects are like burns accompanied by loss of immunity, respiratory failure, and ophthalmic, gastrointestinal, and hematological signs. Ocular effects of SM differ in acute and chronic toxicity. There are no specific antidotes for SM poisoning; hence, preventive medicine and modalities are paramount. So the first and most efficient treatment is to remove and decontaminate the victims. Most of the acute ocular problems heal during a few weeks after exposure, but rare regression of the signs and symptoms can occur up to more than 20 years after exposure, the so-called delayed keratitis that may lead to an uncontrolled penetrating keratoplasty and blindness.

Keywords::

• Sulfur mustard
• war victim
• eye
• ocular
• systemic
• review

Acknowledgment

We are thankful for the kind full cooperation of Iranian Foundation of Martyr and Veterans Affairs and Immunoregulation Research Center of Shahed University, Janbazan Medical and Engineering Research Center (JMERC), and Baqiyatallah Hospital and library to permit us accessibility and application of their last researches and thesis worked on the SM. We offer our best regards to those Scientifics whom cooperated with us in this way.

Declaration of interest: The authors report no conflicts of interest.