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Ophthalmic manifestations and management considerations for emerging chemical threats

Chemical agents have been utilized for centuries in warfare and pose a health threat to civilians and military personnel during armed conflict. Despite treaties and regulations against their use, chemical agent exposure remains a threat and measures to understand their effects and countermeasures fo...

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Autores principales: Menke, Bryant A., Ryu, Christine, Justin, Grant A., Chundury, Rao V., Hayek, Brent R., Debiec, Matthew R., Yeh, Steven
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10629503/
https://www.ncbi.nlm.nih.gov/pubmed/37941806
http://dx.doi.org/10.3389/ftox.2023.1281041
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author Menke, Bryant A.
Ryu, Christine
Justin, Grant A.
Chundury, Rao V.
Hayek, Brent R.
Debiec, Matthew R.
Yeh, Steven
author_facet Menke, Bryant A.
Ryu, Christine
Justin, Grant A.
Chundury, Rao V.
Hayek, Brent R.
Debiec, Matthew R.
Yeh, Steven
author_sort Menke, Bryant A.
collection PubMed
description Chemical agents have been utilized for centuries in warfare and pose a health threat to civilians and military personnel during armed conflict. Despite treaties and regulations against their use, chemical agent exposure remains a threat and measures to understand their effects and countermeasures for systemic and organ-specific health are needed. Many of these agents have ocular complications, both acute and chronic. This mini-review focuses on key chemical agents including vesicants (mustards, lewisite), nerve agents (sarin, VX), knockdown gasses (hydrogen cyanide), and caustics (hydrofluoric acid). Their ophthalmic manifestations and appropriate treatment are emphasized. Acute interventions include removal of the source and meticulous decontamination, as well as normalization of pH to 7.2–7.4 if alteration of the ocular pH is observed. Besides vigorous lavage, acute therapies may include topical corticosteroids and non-steroid anti-inflammatory therapies. Appropriate personal protective equipment (PPE) and strict donning and doffing protocols to avoid healthcare provider exposure are also paramount in the acute setting. For more severe disease, corneal transplantation, amniotic membrane graft, and limbal stem cell transplantation may be needed. Orbital surgery may be required in patients in whom cicatricial changes of the ocular surface have developed, leading to eyelid malposition. Multidisciplinary care teams are often required to handle the full spectrum of findings and consequences associated with emerging chemical threats.
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spelling pubmed-106295032023-11-08 Ophthalmic manifestations and management considerations for emerging chemical threats Menke, Bryant A. Ryu, Christine Justin, Grant A. Chundury, Rao V. Hayek, Brent R. Debiec, Matthew R. Yeh, Steven Front Toxicol Toxicology Chemical agents have been utilized for centuries in warfare and pose a health threat to civilians and military personnel during armed conflict. Despite treaties and regulations against their use, chemical agent exposure remains a threat and measures to understand their effects and countermeasures for systemic and organ-specific health are needed. Many of these agents have ocular complications, both acute and chronic. This mini-review focuses on key chemical agents including vesicants (mustards, lewisite), nerve agents (sarin, VX), knockdown gasses (hydrogen cyanide), and caustics (hydrofluoric acid). Their ophthalmic manifestations and appropriate treatment are emphasized. Acute interventions include removal of the source and meticulous decontamination, as well as normalization of pH to 7.2–7.4 if alteration of the ocular pH is observed. Besides vigorous lavage, acute therapies may include topical corticosteroids and non-steroid anti-inflammatory therapies. Appropriate personal protective equipment (PPE) and strict donning and doffing protocols to avoid healthcare provider exposure are also paramount in the acute setting. For more severe disease, corneal transplantation, amniotic membrane graft, and limbal stem cell transplantation may be needed. Orbital surgery may be required in patients in whom cicatricial changes of the ocular surface have developed, leading to eyelid malposition. Multidisciplinary care teams are often required to handle the full spectrum of findings and consequences associated with emerging chemical threats. Frontiers Media S.A. 2023-10-18 /pmc/articles/PMC10629503/ /pubmed/37941806 http://dx.doi.org/10.3389/ftox.2023.1281041 Text en Copyright © 2023 Menke, Ryu, Justin, Chundury, Hayek, Debiec and Yeh. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Toxicology
Menke, Bryant A.
Ryu, Christine
Justin, Grant A.
Chundury, Rao V.
Hayek, Brent R.
Debiec, Matthew R.
Yeh, Steven
Ophthalmic manifestations and management considerations for emerging chemical threats
title Ophthalmic manifestations and management considerations for emerging chemical threats
title_full Ophthalmic manifestations and management considerations for emerging chemical threats
title_fullStr Ophthalmic manifestations and management considerations for emerging chemical threats
title_full_unstemmed Ophthalmic manifestations and management considerations for emerging chemical threats
title_short Ophthalmic manifestations and management considerations for emerging chemical threats
title_sort ophthalmic manifestations and management considerations for emerging chemical threats
topic Toxicology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10629503/
https://www.ncbi.nlm.nih.gov/pubmed/37941806
http://dx.doi.org/10.3389/ftox.2023.1281041
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