Correlation of Delayed Mustard Gas Ocular Complications with Severity of Skin, Respiratory, Hematologic, and Immunologic Complications

To determine any possible correlation between delayed ocular complications with late-onset complications of mustard gas poisoning in other systems including skin, respiratory tract, and immunohematologic system. The study was conducted on 40 chemical war victims in Khorasan province, Iran. Ophthalmologic and dermatologic examinations and spirometry were performed for all patients. The severity of ocular, cutaneous, and respiratory complications were classified into four grades from mild to severe. Blood cell counts, flow-cytometric analyses, serum immunoglobulins and complement measurements were performed for all patients and for 35 healthy male controls. Hematological and immunological parameters were compared between the patients and the controls, using Mann-Whitney test. The correlation between these parameters and the severity of ocular complications in patients were determined, using Spearman's rank correlation test. Forty male patients (aged 43.8±9.8 years) with confirmed mustard gas poisoning 16 to 20 years after exposure were studied. Main ocular complications were found as vascular tortuosity (15%), limbal ischemia (12.5%), corneal opacity (10%), corneal vascularization (7.5%), and corneal epithelial defect (5%). The values for WBC, RBC, HCT, IgM, and C3, as well as for the percentage of monocytes and CD3+ lymphocytes were significantly higher (p<0.042) and the percentage of CD16+56+ cells was significantly lower in patients than controls (P=0.006). No significant correlation was found between the immunological parameters and the severity of ocular complications. The comparison of clinical complications in the skin, eyes, and respiratory system revealed a significant positive correlation between the respiratory and ocular complications (r=0.322, P=0.043). Although sulfur mustard is known to cause long lasting systemic toxicity such as hematological and immunological complications, its adverse effects on the skin, eyes and the respiratory system are mainly due to its local irritant effects and do not have any relationship with immunohematological complications