Mustard Gas-Induced Ocular Injuries: A Review of Manifestations and Managements

Purpose: To review ocular surface abnormalities caused by exposure to mustard gas and current approaches to manage its delayed-onset complications Methods: A total of 198 medical articles related to mustard gas were reviewed using known international medical databases, 114 articles were more relevant to the main aim were selected. Results: Mustard gas-related ocular injuries can be divided into immediate and late phases. Acute manifestations of varying degrees include eyelid erythema and edema, chemosis, subconjunctival hemorrhage, and epithelial edema, punctate erosions, and corneal epithelial defects. Late complications can cause progressive and permanent reduction in visual acuity (VA) and even blindness and occur in approximately 0.5% of those initially severely wounded. These complications consist of chronic blepharitis, decreased tear meniscus, conjunctival vessel tortuosity, limbal stem cell deficiency, corneal scarring and thinning, and lipid/amyloid deposits. Management of the late complications varies from symptomatic treatment to surgical interventions for dry eye, corneal epithelial instability, limbal stem cell deficiency, and corneal opacity. Conclusion: Mustard gas-related ocular complications are progressive and some sort of surgical interventions may be ultimately required. A long-term and meticulous follow-up for these patients is warranted.