Arch Iran Med. 2022;25(9): 647-657.
doi: 10.34172/aim.2022.100
  Abstract View: 169
  PDF Download: 125

Review Article

Ophthalmic Complications and Managements of Sulfur Mustard Exposure: A Narrative Review

Seyed Hosein Ghavami Shahri 1 ORCID logo, Mahdi Balali-Mood 2, Hamid Reza Heidarzadeh 1, Mojtaba Abrishami 1,3* ORCID logo

1 Eye Research Center, Mashhad University of Medical Sciences, Birjand, Iran
2 Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran
3 Ocular Oncology Service, Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Canada
*Corresponding Author: Corresponding Author: Mojtaba Abrishami, MD, MSc; Email: , Email: mojtaba_abrishami@yahoo.com


Sulfur mustard (SM) is a lethal chemical agent that affects many organs, particularly the eyes, respiratory system and skin. Even asymptomatic patients with documented SM vapor exposure may develop organ disorder many years later. Patients with even minor signs in the acute stage may experience late complications that necessitate surgery. Early decontamination and conservative measures could help the patients and decrease the complications. Despite decades of research, there is still no effective treatment for either acute or long-term SM-induced ocular complications. Even after multiple medications and surgical procedures, the majority of patients continue to have symptoms. For dry eye, punctual occlusion, autologous eye drops, and aggressive lubrication are used; for persistent epithelial defects (PED), tarsorrhaphy, amniotic membrane transplant, and stem cell transplantation are used; for total limbal stem cell deficiency (LSCD), living-related conjunctivolimbal allograft and keratolimbal allograft are used; for corneal vascularization, steroids, non-steroidal anti-inflammatory drugs, and anti-vascular endothelial growth factor prescribed; and for corneal opacities, corneal transplantation is done. Platelet rich plasma and topical drops containing stem cell transplantation for LSCD, photodynamic therapy paired with subconjunctival or topical anti-vascular endothelial growth factors for corneal vascularization, topical curcumin and topical ciclosporin-A for dry eye, and orbital fat-derived stem cells for PED are all alternative treatments that can be suggested. Despite the experimental and clinical research on the complications of SM exposure over the past decades, there is still no effective treatment for eye complications. However, supportive medical and surgical management has been applied with relatively good outcome.

Cite this article as: Ghavami Shahri SH, Balali-Mood M, Heidarzadeh HR, Abrishami M. Ophthalmic complications and managements of sulfur mustard exposure: a narrative review. Arch Iran Med. 2022;25(9):647-657. doi: 10.34172/aim.2022.100
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Submitted: 30 Apr 2022
Accepted: 23 May 2022
ePublished: 01 Sep 2022
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