Ophthalmic Research Center, Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Ocul Surf. 2011 Jul;9(3):163-78. doi: 10.1016/s1542-0124(11)70026-x.
Sulfur mustard is a vesicant agent with severe irritating effects on living tissues, including skin, mucous membranes, eyes, and respiratory tract. The eyes are the most susceptible tissue to mustard gas effects, and varying degrees of ocular involvement are seen in 75% to 90% of exposed individuals. Most cases resolve uneventfully; however, a minority of exposed patients will have a continuous process, which manifests clinically either as a persistent smoldering inflammation (chronic form) or late-onset lesions appearing many years after a variable "silent" period (delayed form). Distinctive features common to most cases with chronic involvement include chronic blepharitis, meibomian gland dysfunction, dry eye, limbal ischemia, limbal stem cell deficiency, aberrant conjunctival vessels, corneal neovascularization, and secondary degenerative changes, including lipid and amyloid deposition and corneal irregularity, thinning and scarring. Most cases can be managed with conservative measures, eg, preservative-free artificial tears, lubricants, and topical steroids. Punctal plugs or punctal cauterization is helpful in moderate and severe forms of injury. Surgical modalities, including lateral or medial tarsorrhaphies, amniotic membrane transplantation, lamellar or penetrating keratoplasty, and stem cell transplantation have been used.
芥子气是一种具有严重刺激性的糜烂性毒剂，会对包括皮肤、黏膜、眼睛和呼吸道在内的活体组织造成损害。眼睛是对芥子气效应最敏感的组织，75%至 90%的暴露个体都会出现不同程度的眼部受累。大多数病例会顺利康复；然而，少数暴露于芥子气的患者会出现持续的过程，临床上表现为持续性的缓慢炎症（慢性型）或在一段可变的“静默”期（潜伏期）后多年出现的迟发性病变（迟发型）。大多数慢性受累病例的共同特征包括慢性睑缘炎、睑板腺功能障碍、干眼症、角膜缘缺血、角膜缘干细胞缺乏、结膜血管异常、角膜新生血管形成以及继发性退行性改变，包括脂质和淀粉样沉积以及角膜不规则、变薄和瘢痕形成。大多数病例可以通过保守治疗来管理，例如无防腐剂的人工泪液、润滑剂和局部类固醇。对于中重度损伤，泪点塞或泪点烧灼术也有帮助。手术方法包括外侧或内侧睑缘缝合术、羊膜移植术、板层或穿透性角膜移植术和干细胞移植术等。
