Sulfur Mustard-Induced Ocular Injuries: Update on Mechanisms and Management
2017
Sulfur mustard (SM; mustard gas) is a classic chemical warfare agent that has been used in several
wars and is still a potential threat especially in the Middle-East region. Victims experience acute symptoms in airexposed
organs including skin, respiratory tract and the eyes. Survivors of the acute stage might develop chronic
or delayed-onset complications in the exposed organs. The exact mechanism(s) of SM-induced tissue damage is
still unknown, however DNA alkylation and oxidative damage are the most relevant mechanisms. Eye is the most
sensitive organ to the SM vapor and ocular symptoms usually precede other manifestations. Ocular findings including
blepharitis, dry eye disease, corneal vascularization, persistent epithelial defects, limbal ischemia, limbal
stem cell deficiency, corneal thinning, corneal opacity and corneal innervation abnormalities have been reported
several years after SM exposure. In this review, mechanisms of acute and chronic/delayed ocular manifestations
of SM and their current management and potential future therapies have been discussed. We have also included
recent advances in amniotic membrane transplantation, cultivated stem cell transplantation and anti-angiogenic
therapies which might be considered as therapeutic options in SM-induced ocular damage in the future.
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