Ocular injuries

The eyes are the organs most sensitive to SM injury. Acute effects are conjunctivitis, with dry eye, pain and photophobia. More than 60% of eye injuries recover and vision is restored. The remaining patients develop chronic or delayed-onset mustard gas keratopathy (MGK). Khateri et al (2003) reported that 35% of injured veterans had mild ocular injury (dry eye, conjunctival scarring and decreased visual acuity) and 3.6% had moderate injury that included some corneal involvement. Severe symptoms were described in fewer than 1% of patients. MGK is characterized by chronic blepharitis, meibomian gland dysfunction, dry eye, perilimbal conjunctival ischemia. 

---

Exposure of the eyes has resulted in mild to severe injury. The severity of ocular injury was dependent on the length of time from exposure to adequate lavage. Delayed keratitis has also been reported. 

Fraunfelder FT, Coster DJ, Drew R, et ah Ocular injury induced by methyl ethyl ketone... 

Soiutions and suspensions - Most topical ocular preparations are commercially available as solutions or suspensions that are applied directly to the eye from the bottle, which serves as the eye dropper. Avoid touching the dropper tip to the eye because this can lead to contamination of the medication and also may cause ocular injury. Resuspend suspensions (notably, many ocular steroids) by shaking to provide an accurate dosage of drug. 

V f/T enfs - The primary purpose for an ophthalmic ointment vehicle is to prolong drug contact time with the external ocular surface. This is particularly useful for treating children, who may cry out topically applied solutions, and for medicating ocular injuries, such as corneal abrasions, when the eye is to be patched. Administer solutions before ointments. Ointments preclude entry of subseguent drops. 

Hughes reviewed mainly British and European reports and cited official British data estimating that 75-90% of mustard gas casualties had some degree of ocular Injury. A rough estimate, based on information reported by Case and Lea,13 indicates a little over 100,000 cases of eye Injury. Hughes stated that about 10% of these injuries resulted In corneal erosion, which he considered predictive of visual degeneration. Corneal transplants or contact lenses could be expected to help many patients. 

In a retrospective study of 148 cases of occupational eye injuries in Germany, ocular bums (not specified as chemical or other etiology) comprised 15.5% of the total [10]. In another German study of 101 patients with 131 severely burned eyes, 72.3% of the injuries were work-related, 84.2% were chemical injuries, and 79.8% of these were due to alkalis [11], Of 42 cases of alkali ocular bums admitted to a German eye clinic between 1985 and 1992, 73.8% involved industrial accidents [19]. In Finland in 1973,11.9% of all industrial accidents were ocular injuries and bums comprised 3.6% of these (chemical or other injury mechanism not specified) [12]. A 7-year retrospective Australian study of 182 industrial bums found that 5.5% were ocular bums due to chemicals, gas explosions, and electric flashes (percentages not specified) [30]. In a 4-year hospital-based study in Taiwan, of 486 patients with eye injuries, 39.9% were work-related [20]. Chemical ocular bums accounted for 19.6% of these injuries [20],... 

Saini and Sharma [30] reported a series of 145 chemical eye injuries in 102 patients treated at a major referral center in India between 1984 and 1991 [30]. Bilateral injuries were seen in 42.1% of patients. Acids and alkalis accounted for 80% of chemical ocular injuries in this series. Two-thirds of the injuries occurred in young people working in laboratories and factories. Roper-Hall Grade III and IV injuries were seen in 52 eyes (35.9%). In total, 102 eyes (70.3%) recovered with a visual acuity of 6/60 or better. Ten eyes (6.9%) had no light perception. Phthis bulbi (a deformed eyeball with no light perception) occurred in 71.4% of the seven deliberate chemical assault victims but in only 3.6% of the accidental ocular chemical exposures. The final visual acuity was better in the eyes with less severe grades of chemical injuries on presentation [30],... 

Cartotto et al. [34] reported a series of patients treated at the bum center in Toronto, Ontario, Canada [34], Of the total 24 chemical bum cases, there were 8 chemical eye splashes. Five of these eight patients were decontaminated at the scene (presumably with water). The three chemical eye splash patients who did not receive immediate decontamination developed severe ocular injuries. However, three of the five who had immediate decontamination developed comeal erosions and one patient with eye exposure to black liquor developed a very deep comeal erosion leading to blindness [34]. 

Islam, S.S., Doyle, E.J., VeUUa, A., Martin, C.J., Ducatman, A.M. Epidemiology of compensable work-related ocular injuries and illnesses incidence and risk factors. J Occup Environ Med 42, 575-581 (2000)... 

As an introduction to the field of chemical ocular bum lesions, an historical and epidemiological perspective has been reviewed by an historian, an ophthalmologist, and a medical toxicologist. Next, a section is presented covering an expanded review of the mechanisms of action and reactivity of chemicals which can cause ocular injuries, prepared by a group of chemists and physicians. 

Upper airway injury rarely causes delayed pulmonary edema Ocular injury and upper airway injury... 

Ocular injury, upper airway burn, and bronchiectasis... 

L., Kadar, T. (2002). Topical dexamycin treatment against sulfur mustard ocular injury. US Army Medical Defense Bioscience Review 221. 

Safarinejad, M.R., Moosavi, S.A., Montazeri, B. (2001). Ocular injuries caused hy mustard gas diagnosis treatment and medical defense. Mil. Med. 166 67-70. 

Solberg, Y., Alcalay, M., Belkin, M. (1997). Ocular injury by mustard gas. Surv. Ophthalmol. 41 461-6. 

Vidan, A., Luria, S., Eisenkraft, A., Hourvitz, A. (2002). Ocular injuries following sulfur mustard exposure clinical characteristics and treatment. Isr. Med. Assoc. J. 4 511-8. 

Development and validation of in vitro and/or in vivo animal models for rapid screening of molecular hbraries to identify potential medical countermeasures is another priority of the CounterACT program. These models include seizures in small mammals, models of direct lung injury from an inhaled source, animal models of cyanide intoxication, and medium throughput models of dermal or ocular injuries. It is important that models be amenable to use under GLP methodology so that the data generated are acceptable to the FDA. Since adherence to GLP standards may be expensive, earher screens to identify potential hits are usually performed under non-GLP conditions. 

McCombe M, Heriot W. Penetrating ocular injury following local anaesthesia. Aust NZ J Ophthalmol 1995 23(l) 33-6. 

Mansour-Robaey, S., Clarke, D. B., Wang, Y. C., Bray, G. M., and Aguayo, A. J., Effects of ocular injury and administration of brain-derived neurotrophic factor on survival and regrowth of axotomized retinal ganglion cells, Proc. Natl. Acad. Sci. U.S.A., 91, 1632, 1994. 

---