Elsevier, Survey of Ophthalmology, 4(61), p. 434-442, 2016
DOI: 10.1016/j.survophthal.2016.01.002
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Chemical agents that target the eyes have been a popular choice for law enforcement during riots and for military training for nearly a century. The most commonly used agents are chloroacetophenone (CN, formerly sold as Mace®), o-chloro-benzylidene malononitrile (CS), and oleoresin capsicum (OC or pepper spray, current ingredient for Mace®). Initially, the majority of severe ocular injuries were caused by the explosive force rather than the chemical itself. The development of sprays reduced the severity of ocular injuries, but resulted in a variety of chemical injuries. The effects on eyes include conjunctival injection, complete corneal epithelial defects, pseudo-pterygium, corneal neovascularization, persistent conjunctivalization, corneal opacities, and reduced visual acuity. Current management, based on limited human studies, emphasizes decontamination and symptomatic treatment. We review the literature related to clinical and histopathological effects of tear gas agents on the eye and their management.