The delayed ocular and pulmonary complications of mustard gas

Background: Sulfur mustard has been a popular chemical warfare agent in the twentieth century. This agent was used in the Iraqi-Iranian conflict in 1983-88. The casualties exposed to sulfur mustard have exhibited acute and chronic complications in the eye, lungs, and skin. Around 15 years post exposure to sulfur mustard, we performed this study to evaluate the severity of the delayed complications in the eyes and the respiratory system. Material and Methods: In this descriptive study, we evaluated 500 male subjects in the age range of 30-50 years, in 2001. These soldiers' first intoxification to sulfur mustard was confirmed by the Department of Medical Consultation of the Janbazan Organization (the Iranian Veterans' Affairs Agency). Complete ocular and pulmonary examinations were performed. The complications were divided into three grades of mild, moderate, and severe. In order to be classified in a certain grade of severity, the patient must have exhibited at least 50% of the designated signs and symptoms in that category. The frequencies of the patients in each grade were reported and chi-square analysis was performed. Results: The distribution of the subjects within each grade of the complications was as follows: mild ocular, 80%; moderate ocular, 13.2%; severe ocular, 6.8%; mild pulmonary, 69.2%; moderate pulmonary, 19.6%; and severe pulmonary, 11.6%. The distribution of the patients within the different grades of the ocular and pulmonary complications concurrently was as follows: mild ocular and pulmonary complications, 57.2%; moderate ocular and pulmonary complications, 2%; and severe ocular and pulmonary complications, 1.4%. Of all the patients, 14.8% had more severe ocular complications and 24.6% had more severe pulmonary complications. The pulmonary complications were present in higher severity than the ocular complications and statistically the relationship was significant (P < 0.005). Conclusion: In this study, all of the subjects exhibited at least mild ocular and pulmonary complications, around 15 years post exposure to sulfur mustard. The severity of the pulmonary complications is higher than the ocular complications. We conclude that these chronic complications are rising. The subjects with no or mild complications in earlier years might develop more severe complications in the future. From the previous cytological studies, it is apparent that the changes induced due to exposure to sulfur mustard are at the cellular structural levels. These changes are not easily reversible or treatable. The proper management of these individuals, with the possible rise in the severity of their complications, remains a major health concern.