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Cynthia R. Lewis-Younger, MD, MPH; Nick Mamalis, MD; Marlene J. Egger, PhD; David O. Wallace, MSPH; Chun Lu, MPH

Arch Ophthalmol. 2000;118:1653-1659.

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.

From the Departments of Family and Preventive Medicine (Drs Lewis-Younger and Egger, Mr Wallace, and Ms Lu); and Ophthalmology (Dr Mamalis), University of Utah, Salt Lake City.

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