新出现的化学威胁的眼科表现和管理注意事项。

IF 3.6 Q2 TOXICOLOGY
Frontiers in toxicology Pub Date : 2023-10-18 eCollection Date: 2023-01-01 DOI:10.3389/ftox.2023.1281041
Bryant A Menke, Christine Ryu, Grant A Justin, Rao V Chundury, Brent R Hayek, Matthew R Debiec, Steven Yeh
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引用次数: 0

摘要

几个世纪以来,化学制剂一直被用于战争,在武装冲突期间对平民和军事人员的健康构成威胁。尽管有禁止使用化学制剂的条约和条例,但接触化学制剂仍然是一种威胁,需要采取措施了解其对系统和器官特定健康的影响和对策。这些制剂中的许多都有急性和慢性眼部并发症。这篇小型综述的重点是关键的化学制剂,包括发泡剂(芥末、路易氏剂)、神经毒剂(沙林、VX)、击倒气体(氰化氢)和腐蚀剂(氢氟酸)。强调其眼科表现和适当的治疗。急性干预措施包括去除来源和细致的去污,以及如果观察到眼睛pH值发生变化,将pH值正常化至7.2-7.4。除了剧烈灌洗外,急性治疗可能包括局部皮质类固醇和非类固醇抗炎治疗。在急性情况下,适当的个人防护装备(PPE)和严格的穿脱协议也至关重要,以避免医护人员接触。对于更严重的疾病,可能需要角膜移植、羊膜移植和角膜缘干细胞移植。眼表瘢痕性变化导致眼睑错位的患者可能需要进行眼眶手术。通常需要多学科护理团队来处理与新出现的化学威胁相关的全方位发现和后果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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 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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CiteScore
3.80
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