Eyes are very sensitive to sulfur mustard (SM) gas because they have wet surfaces. The severity of ocular damage is related to the dose and duration of exposure to SM, and recovery may take up to several years after the exposure. We conducted a large cohort study to evaluate the ocular signs and symptoms of 367 chemical war victims in Sardasht City, Iran, 20 years after their exposure to mustard gas. The results of these chemical war victims (i.e., the cases) were compared with the results for 128 unaffected civilians (i.e., the controls). Photophobia was the most significant symptom in the cases (36.8%) (compared with 20.3% in the controls) (p ≤ .001). Ocular surface discomfort (burning, itching, and redness) was the second most significant symptom in the cases (29.2%) (compared with 19.5% in the controls) (p=.034). Other symptoms such as foreign-body sensation, tearing, pain, blurring of vision, and dry eye sensation were not significantly different between the 2 groups. In the slit-lamp findings, bulbar conjunctival abnormality was the most significant sign in the cases (9.3%) (compared with 1.6% in the controls) (p=.004). Limbal tissue changes were the second most significant sign in the cases (3.0%) (compared with 0.0% in the controls) (p=.048). Other slit-lamp findings related to tearing and abnormalities in the lids and cornea were not significantly different between the 2 groups. Our findings in the present study showed that photophobia and ocular surface discomfort (burning, itching, and redness) were the most significant symptoms. In addition, bulbar conjunctival abnormalities and limbal tissue changes were the most significant signs among the sulfur mustard chemical war victims.

Context: Sulfur mustard (SM), with an old manufacturing history still remains as potential threat due to easy production and extensive effects. Objectives: Increasing studies on SM indicates the interest of researchers to this subject. Almost all human body organs are at risk for complications of SM. This study offers organ-by-organ information on the effects of SM in animals and humans. Methods: The data sources were literature reviews since 1919 as well as our studies during the Iraq–Iran war. The search items were SM and its all other nomenclatures in relation to, in vivo, in vitro, humans, animals, eye, ocular, ophthalmic, lungs, pulmonary, skin, cutaneous, organs and systemic. Amongst more than 1890 SM-related articles, 257 more relevant clinicopathologic papers were selected for this review. Results: SM induces a vast range of damages in nearly all organs. Acute SM intoxication warrants immediate approach. Among chronic lesions, delayed keratitis and blindness, bronchiolitis obliterans and respiratory distress, skin pruritus, dryness and cancers are the most commonly observed clinical sequelae. Conclusion: Ocular involvements in a number of patients progress toward a severe, rapid onset form of keratitis. Progressive deterioration of respiratory tract leads to “mustard lung”. Skin problems continue as chronic frustrating pruritus on old scars with susceptibility to skin cancers. Due to the multiple acute and chronic morbidities created by SM exposure, uses of multiple drugs by several routes of administrations are warranted.

Sulfur mustard (SM) was the most common chemical warfare agent used by Iraqi military forces against Iranian soldiers and civilians in border towns. Studies about late skin complications in SM-exposed people and its comparison with those in a proper control group are limited. The present paper, which is a part of the Sardasht-Iran Cohort Study is concerning with the skin findings of SM exposure 20 years after the chemical bombardment of Sardasht town (Iran) in comparison with the skin findings of the Rabat population. There are two major subgroups of SM exposure: a hospitalized group with moderate to severe problems at exposure time (n = 168), and a not hospitalized group with mild problems (n = 194), and the other is a control group (n = 128) selected from Rabat. Each participant was examined by a dermatologist in the research team. The most common skin lesions in the exposed groups based on their frequency were: eczema (27.6%), xerosis (24.6%), cherry angioma (19.9%), hyperpigmentation (15.5%), mustard scar (14.6%) and seborrheic dermatitis (10.8%), but in the control group, they were: eczema (28.9%), xerosis (11.7%), seborrheic dermatitis (11.7%) and cherry angioma (9.4%). In the exposed group, itching (P < 0.001), burning (P = 0.037), xerosis (P = 0.002), hyperpigmentation (P = 0.002) and cherry angioma (P = 0.007) were seen more often than in the control group and the differences were statistically significant. It is concluded that SM exposure causes significant delayed skin findings. In the exposed group, further follow up was needed for more long-term skin complications such as skin cancers, and there are many questions about the underlying pathophysiology and immunology of SM cutaneous complications that should be investigated.