ABSTRACT
To evaluate the microbiological characteristics of lid margin flora in chronic blepharitis in individuals exposed to mustard gas in comparison to nonexposed patients. In this case-control study, among 289 patients with documented ocular manifestations of mustard gas, 150 patients with clinical sings of blepharitis served as the case group. Microbiologic evaluation was conducted in these patients and compared to that of 100 unexposed patients with chronic blepharitis. In 150 patients with mustard gas exposure and chronic blepharitis, staphylococcus epidermidis [78%] and staphylococcus aureus [57%] were significantly higher than control group [P< 0.01]. Moreover, staphylococcus aureus had more resistance to common antibiotics in the case group. Fungi were isolated more frequently in cases compared with controls [30% vs. 4%, P<0.01]. Cladosporium and Candida were the most common species. Microbiological evaluation in patients with chronic blepharitis associated with mustard gas is significantly different from other patients. Staphylococcus spp, including strains resistant to Methicillin, and fungi were more frequently isolated in exposed patients. The relationship between microbial culture and the severity of ocular manifestations in mustard gas exposed cases warrants further investigation
ABSTRACT
Background and Purpose: Eyes are among the most sensitive organs to chemical agents especially Sulfur mustard or Hun Distilled. Therapeutic effects of anti-inflammatory drugs have been shown on the decrease of epithelium of corneal injuries after being exposed to sulfur mustard. The aim of the present study was to evaluate the protective effects of topically applied Bethametazone - Diclofenac Na in rabbits
Materials and Methods: In this experimental research, thirty six rabbits were used. Animals were randomly divided into six equal groups [6 rabbits in each group] including control, solution and mustard groups and prophylaxis groups included Betamethasone, Diclofenac Na; Betamethasone-Diclofenac Na were applied before being exposed to the sulfur mustard solution. Animals were kept for 2 weeks and the drugs were used 3 times a day for 2 weeks. Slit-lamp examinations were performed under anesthesia before exposure and subsequently at days 1, 2, 5, 7, and 14 after sulfur mustard exposure by ophthalmologists. At the end of the 14th day, specimens of cornea were obtained for ultrastructural evaluation of corneal epithelium. Statistical analysis was performed by one way analysis of variance [ANOVA] with Tukey's test using SPSS 13 software
Results: No significant differences were found between the control and solvent groups as far as the variables were concerned. Corneal epithelial defect and severe changes in ultrastructure of corneal epithelial surface was found in the sulfur mustard group. Clinically, corneal epithelial defect in prophylactic Diclofenac Na group [4.2 +/- 1.32] decreased significantly when compared to the mustard group [68.7 +/- 8.42] [P=0.034]. Betamethasone-Diclofenac Na group [4.2 +/- 1.17] also decreased significantly when compared to the mustard group [68.7 +/- 8.42] [P=0.031]. The corneal epithelial defect was not seen in prophylactic Betamethasone group. Ultrastructural damage of corneal epithelial surface and their microvillus in Betamethasone group was similar to the control group
Conclusion: Betamethazone is capable of protecting corneal epithelial defect in the eyes of rabbits exposed to sulfur mustard
ABSTRACT
Purpose: to report the clinical features of 93 eyes with chronic and delayed onset mustard gas keratitis in 48 patients
Methods: forty-eight Iranian survivors of Iraqi chemical warfare with chronic or delayed onset mustard gas keratitis were enrolled. We reviewed the symptoms, signs, clinical course, and treatment of our patients. In 5 cases, histopathologic features of corneal and conjunctival specimens are presented
Results: of 48 patients, 3 1 [64.6%] had chronic symptomatology whereas 17 [3 5.4%] experienced delayed onset lesions. Visual acuity at referral ranged from hand motions to 20120. Ocular surface changes included chronic blepharitis and decreased tear meniscus in all, limbal ischemia [81.3%] and conjunctival vascular abnormalities [50%]. Corneal signs in order of frequency were: scar/opacity [87.5%], neovascularization [70.8%], thinning [58.3%], lipoid deposits [52. I%], amyloid deposits [43.8%], and epithelial defects and irregularity [3 1.3%]. Twenty patients received conservative treatment; others underwent allograft stem cell transplantation [20 eyes of 17 patients], penetrating keratoplasty [12 eyes of 12 patients], and lamellar keratoplasty [4 eyes of 3 patients]. Conjunctival specimens were evaluated by light microscopy. Decreased goblet cell density, attenuated or thickened epithelium, scarring in the substantia propria associated with plasmacytic and lymphocytic infiltration, and dilated lymphatic vessels were noted. Excised corneal buttons disclosed absence of epithelium and Bowman's layer, firbrovascular pannus, stromal scarring, and vascularization
Conclusion: mustard gas may cause chronic and delayed destructive lesions in the ocular surface and cornea leading to progressive visual deterioration and ocular irritation. The pathophysiology of these changes is not clearly identified. Excised conjunctival and corneal specimens revealed a mixed inflammatory response without any specific features. Based on the clinical appearance of the lesions and histopathologic findings, an immune-mediated component seems possible