Sulfur Mustard-Induced Ocular Surface Disorders
Sulfur Mustard-Induced Ocular Surface Disorders
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DOI：
10.1016/s1542-0124(11)70026-x
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发表时间：
2011-07-01
期刊：
影响因子：
6.4
通讯作者：
Tseng, Scheffer C. G.
中科院分区：
文献类型：
--
作者：
Baradaran-Rafii, Alireza;Eslani, Medi;Tseng, Scheffer C. G.
硫芥是一种起泡剂，对皮肤、粘膜、眼睛和呼吸道等活组织有严重刺激作用。眼睛是最容易受到芥子气影响的组织，75% 至 90% 的暴露者会出现不同程度的眼部受累。大多数案件都能顺利解决；然而，少数暴露的患者会经历一个连续的过程，临床上表现为持续性阴燃炎症（慢性形式）或在可变的“沉默”期多年后出现的迟发性病变（延迟形式）。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、角膜缘缺血、角膜缘干细胞缺乏、结膜血管异常、角膜新生血管和继发性退行性改变，包括脂质和淀粉样蛋白沉积以及角膜不规则、变薄和疤痕。大多数病例可以通过保守措施来治疗，例如不含防腐剂的人工泪液、润滑剂和外用类固醇。泪点塞或泪点烧灼对于中度和重度损伤有帮助。已使用的手术方式包括外侧或内侧睑板缝合术、羊膜移植、板层或穿透性角膜移植术以及干细胞移植。
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 clinic ally 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.