ABSTRACT
CONTEXT: Unusual cataracts (flecks) have been reported to occur at very low levels of trinitrotoluene exposure, but prevalence estimates vary widely. Cataracts have not been reported among workers in the United States exposed to organic nitrate explosives. OBJECTIVES: To determine the prevalence of unusual cataracts in a population of workers in the United States exposed to organic nitrate explosives, to determine whether associations exist with reported cataract risk factors, and to determine if other eye effects (eg, retinal hemorrhage) are associated with exposure. DESIGN: Cohort prevalence study. SETTING: A university-based ophthalmologic clinic. SUBJECTS: Sixty-one workers from an explosives plant comprised the exposed group. The comparison group consisted of 56 workers using chemicals other than organic nitrate explosives. OUTCOME MEASURES: The primary outcome measure was opacifications (flecks) of the crystalline lens, graded clinically on a scale of 0 to 4 +. Additional measures included visual acuity, applanation tonometry, and clinical evaluation using standard examination techniques. RESULTS: Sixty-three percent of the workers had anterior cortical lens opacifications in a pattern of peripheral flecks. Exposed subjects were 18 times more likely to exhibit changes than those not exposed, a statistically significant association (95% confidence interval [CI], 5.0-65.0; P<.001). A statistically significant association with the duration of exposure was also found. CONCLUSIONS: Asymptomatic, low-grade cataracts (flecks) were identified in 63% of the workers exposed to pentolite. No other eye effects were found to be associated with exposure. Cataracts were not associated with other known risk factors, but were associated with the duration of exposure. Biomicroscopy is widely available and useful for detecting changes in the asymptomatic stages.
Subject(s)
Cataract/chemically induced , Lens, Crystalline/drug effects , Occupational Diseases/chemically induced , Occupational Exposure/adverse effects , Pentaerythritol Tetranitrate/adverse effects , Trinitrotoluene/adverse effects , Adult , Cataract/diagnosis , Cataract/epidemiology , Cohort Studies , Drug Combinations , Explosions , Female , Humans , Intraocular Pressure , Lens, Crystalline/pathology , Male , Middle Aged , Occupational Diseases/diagnosis , Occupational Diseases/epidemiology , Odds Ratio , Ophthalmoscopy , Prevalence , Reflex, Pupillary , Refraction, Ocular , Risk Factors , Utah/epidemiology , Visual Acuity , Visual FieldsABSTRACT
BACKGROUND: Although effective at treating mycosis fungoides (MF), nitrogen mustard (HN(2)) creates potential exposure risks to those who administer it, including health care workers and family members. OBJECTIVE: The main objective was to examine the potential for nontarget individuals to be exposed to HN(2) vapors during and shortly after treatment with HN(2) in a home environment. METHODS: Air concentrations of HN(2) were measured during the topical treatment of MF in a patients home. RESULTS: The results demonstrate that eye and mucous membrane irritation may occur at HN(2) levels commonly encountered during the treatment of MF in the home, hospital or health clinic. Because no exposure thresholds have been developed for HN(2), the exposure thresholds of a surrogate chemical (sulfur mustard) were used. CONCLUSIONS: The study findings show that eye and mucous membrane irritation may occur at HN(2) levels below the exposure thresholds of the surrogate chemical. Recommendations for controlling exposures to HN(2) in the home are given.
