Effects of high doses of toluene on color vision

Low-level occupational exposure to BTEX and dyschromatopsia: a systematic review and meta-analysis

Objectives. The present study aimed to assess whether occupational exposure to low concentrations of benzene, toluene, ethylbenzene and xylene (BTEX) is associated with color vision impairment. Methods. We queried PubMed, Scopus, Embase, Web of Science and ProQuest as the main databases, as well as gray literature such as Google Scholar. A random-effects model was used to assess relative risk. A funnel plot was created to assess publication bias. Meta-regression analysis was applied to identify variables that explain the between-study variation in the reported risk estimate. Results. An overall standardized mean difference of 0.529 (95% confidence interval [0.269, 0.788]; p < 0.0001) was obtained in the random-effects model, which corresponded to a medium-size effect. Duration and the levels of exposure to benzene, toluene and xylene were the significant predictors of the magnitude of the combined risk estimate. Chronic exposure to low levels of BTEX was associated with dyschromatopsia determined by the color confusion index. Conclusions. The impairments can occur even at exposures lower than the occupational exposure limits of BTEX. However, there are several flaws in the determination of workers' exposure, which did not allow to establish how low a level of these chemicals can cause color vision impairment.

Application of physiologically-based pharmacokinetic modeled toluene blood concentration in the assessment of short term exposure limits

Toluene is a volatile hydrocarbon with solvent applications in several industries. Acute neurological effects in workers exposed to toluene have been reported in various publications. To inform the basis for a toluene Short Term Exposure Limit (STEL), studies of toluene-exposed workers were modeled using customized exposure scenarios within an existing physiologically-based pharmacokinetic (PBPK) model to simulate blood concentrations during individual studies. Maximum simulated blood concentration ranged from 0.3 to 1.7 (mean = 0.74 mg/L, median = 0.73, upper 95th percentile = 1.07) at the studies identified No Observed Adverse Effect Concentration (NOAEC). Maximum simulated blood concentration ranged from 0.7 to 4.1 mg/L (mean = 1.81, median = 1.63, lower 95th percentile = 0.92) at the studies identified Lowest Observed Adverse Effect Concentration (LOAEC). The maximum blood concentration for a 100 ppm STEL-like simulation was 0.4 mg/L, at the lower end of the NOAEC range and below the 95th percentile of the LOAEC. Therefore, it appears that a STEL <100 ppm would be unnecessary to protect workers due to peak occupational exposures to toluene.

Toluene inhalation exposure for 13 weeks causes persistent changes in electroretinograms of Long-Evans rats

Studies of humans chronically exposed to volatile organic solvents have reported impaired visual functions, including low contrast sensitivity and reduced color discrimination. These reports, however, lacked confirmation from controlled laboratory experiments. To address this question experimentally, we examined visual function by recording visual evoked potentials (VEP) and/or electroretinograms (ERG) from four sets of rats exposed repeatedly to toluene. In addition, eyes of the rats were examined with an ophthalmoscope and some of the retinal tissues were evaluated for rod and M-cone photoreceptor immunohistochemistry. The first study examined rats following exposure to 0, 10, 100 or 1000ppm toluene by inhalation (6hr/d, 5d/wk) for 13 weeks. One week after the termination of exposure, the rats were implanted with chronically indwelling electrodes and the following week pattern-elicited VEPs were recorded. VEP amplitudes were not significantly changed by toluene exposure. Four to five weeks after completion of exposure, rats were dark-adapted overnight, anesthetized, and several sets of electroretinograms (ERG) were recorded. In dark-adapted ERGs recorded over a 5-log (cd-s/m(2)) range of flash luminance, b-wave amplitudes were significantly reduced at high stimulus luminance values in rats previously exposed to 1000ppm toluene. A second set of rats, exposed concurrently with the first set, was tested approximately one year after the termination of 13 weeks of exposure to toluene. Again, dark-adapted ERG b-wave amplitudes were reduced at high stimulus luminance values in rats previously exposed to 1000ppm toluene. A third set of rats was exposed to the same concentrations of toluene for only 4 weeks, and a fourth set of rats exposed to 0 or 1000ppm toluene for 4 weeks were tested approximately 1year after the completion of exposure. No statistically significant reductions of ERG b-wave amplitude were observed in either set of rats exposed for 4 weeks. No significant changes were observed in ERG a-wave amplitude or latency, b-wave latency, UV- or green-flicker ERGs, or in photopic flash ERGs. There were no changes in the density of rod or M-cone photoreceptors. The ERG b-wave reflects the firing patterns of on-bipolar cells. The reductions of b-wave amplitude after 13 weeks of exposure and persisting for 1year suggest that alterations may have occurred in the inner nuclear layer of the retina, where the bipolar cells reside, or the outer or inner plexiform layers where the bipolar cells make synaptic connections. These data provide experimental evidence that repeated exposure to toluene may lead to subtle persistent changes in visual function. The fact that toluene affected ERGs, but not VEPs, suggests that elements in the rat retina may be more sensitive to organic solvent exposure than the rat visual cortex.

Retinal and visual system: occupational and environmental toxicology

Occupational chemical exposure often results in sensory systems alterations that occur without other clinical signs or symptoms. Approximately 3000 chemicals are toxic to the retina and central visual system. Their dysfunction can have immediate, long-term, and delayed effects on mental health, physical health, and performance and lead to increased occupational injuries. The aims of this chapter are fourfold. First, provide references on retinal/visual system structure, function, and assessment techniques. Second, discuss the retinal features that make it especially vulnerable to toxic chemicals. Third, review the clinical and corresponding experimental data regarding retinal/visual system deficits produced by occupational toxicants: organic solvents (carbon disulfide, trichloroethylene, tetrachloroethylene, styrene, toluene, and mixtures) and metals (inorganic lead, methyl mercury, and mercury vapor). Fourth, discuss occupational and environmental toxicants as risk factors for late-onset retinal diseases and degeneration. Overall, the toxicants altered color vision, rod- and/or cone-mediated electroretinograms, visual fields, spatial contrast sensitivity, and/or retinal thickness. The findings elucidate the importance of conducting multimodal noninvasive clinical, electrophysiologic, imaging and vision testing to monitor toxicant-exposed workers for possible retinal/visual system alterations. Finally, since the retina is a window into the brain, an increased awareness and understanding of retinal/visual system dysfunction should provide additional insight into acquired neurodegenerative disorders.

Chemical exposure in occupational settings and related health risks: a neglected area of research in Pakistan

In Pakistan a huge number of workers is routinely exposed to various types of chemical contaminants but there is a dearth of information as to the impact of these agents, due to a lack of a routine surveillance system and proper reporting. Prolonged and sometimes acute occupational exposures to varied organic chemicals may result in numerous health related problems. Studies from all over the world have shown adverse health outcomes of chemicals that are commonly used in various occupations. Such chemical exposures are not just confined to the workplace, but the residents surrounding industrial sites also face significant health risks due to indirect chemical exposure. Occupational exposure is a multidimensional risk factor that varies from one occupation to another, and is associated with health decline in workers. Common determinants of workplace hazards include improper, or lack of use of self-protective equipment, active and passive exposure to cigarette smoke as well as the socio-demographic and economic background of workers. There may be more than one cause of occupational stress and psychophysical disturbance among workers such as workload, lower salaries, and lack of social and medical facilities; indeed, their general health is poor. Therefore, in Pakistan, it is particularly important to focus on these issues and set rules and regulations to create occupational hazard awareness among workers, which will promote health safety at work places. If priorities are given to the correct use of self-protective equipment, adopting proper hygiene at the workplace and to avoid smoking, occupational exposures and consequent health risks may be minimized significantly.

Indoor contaminants from newspapers: VOCs emissions in newspaper stands

Mean volatile organic compound (VOC) concentrations in 16 newspaper stands and in two printing shops were monitored for the purpose of quantifying the various VOCs in these areas and to relate the results. In each site halogenated, oxygenated, aliphatic, and aromatic compounds were monitored during one workweek. They were sampled with diffusive samplers for thermal desorption and analysed by GC-MS. The results showed that in all newspaper stands the indoor levels of toluene were much higher than the outdoor levels; some sites had toluene indoor concentrations 100 times higher than their correspondent outdoor levels. The investigations in two printing shops confirmed that newspapers, in particular the inks, are the main sources of toluene in the newspaper stands.

Occupational Exposure to Volatile Organic Compounds and Mitigation by Push‐Pull Local Exhaust Ventilation in Printing Plants

The extensive use of multiple organic solvents in offset lithographic printing causing high emissions of volatile organic compounds (VOCs) indeed poses a serious risk to printing workers' health. In this study, indoor air quality (IAQ) assessments were carried out in seven printing plants and the main objectives were to understand the effect of VOC emissions on IAQ and develop effective mitigation measures to protect workers. The thorough gas chromatography/mass spectrometry (GC/MS) measurements showed that although a variety of VOCs were presented in the indoor air, none of them was found close to individual 8-h time-weighted average (TWA) of the occupational exposure limit (OEL). The additive effect was also found below the critical value of unity. However, short-term personal exposure to total volatile organic compounds (TVOCs) was exceedingly high when a print worker carried out blanket and ink roller cleaning procedures. Therefore, the occupational health risk was mainly due to repeated short-term exposures during intermittent VOC-emitting procedures rather than long-term exposure to background VOCs. Push-pull local exhaust ventilation (LEV) was identified as an effective mitigation measure. Computational fluid dynamics (CFD) analysis was conducted to study the push-pull LEV operation. It was found that there existed a threshold LEV air flow rate for an abrupt reduction in the worker's exposure to VOCs. The reduction was less sensitive when the LEV airflow was further increased beyond the threshold. These phenomena, consistent with experimental results reported by other investigators, were explained by detailed CFD analysis showing the competition between the general ventilation and the push-pull LEV to become the dominating driving force for the resultant local flow pattern.

Changes of neurobehavioral and sensory functions due to toluene exposure below 50ppm?

Data of a follow up study with four examinations were summarized by odds ratio statistics in order to scrutinize the results of the earlier studies with cross sectional approaches. For a "high"- (n=106) and a "low"-exposed group (references, n=86) current toluene exposures of 26ppm versus 3ppm and lifetime weighted average exposures of 45ppm versus 9ppm were ascertained. As measures of sensory functions vibration thresholds, colour discrimination, and auditory thresholds were used. Measures of psychological performances were attention (symbol-digit substitution, switching attention, simple reaction), memory (digit span forward, delayed reproduction of pictures), and psychomotor functions (steadiness, line tracing, aiming, tapping, peg board). Additionally, the frequency of diseases and symptoms were ascertained. By odds ratio statistics including relevant cofactors no significant increase of "cases with impaired functions" among the high-exposed workers was found. Evidence for neurobehavioral effects due to long-term toluene exposure below 50ppm was not established.

Effect of petroleum derivatives and solvents on colour perception

BACKGROUND

Occupational exposure to various neurotoxic chemicals has been shown to be associated with colour vision impairment. It seems that this can occur at low exposure levels, sometimes well below the recommended occupational threshold limits. This study was undertaken to determine the effect of exposure to petroleum derivatives (polyethylene, polystyrene) and solvents (perchloroethylene) on colour perception.

METHODS

Colour vision was assessed using the Ishihara plates, the D-15 test and the Farnsworth Munsell 100 Hue test. Two factories using petroleum derivatives and three dry cleaning premises were chosen at random. A total of 93 apparently healthy employees were recruited from the five workplaces. Two age-matched control groups comprising 56 people, who were support staff of the university with no exposure to petroleum, solvents or their derivatives, were also recruited.

RESULTS

All subjects passed the Ishihara test, showing that none had a congenital red-green defect. Some of the exposed employees failed the D-15 and had abnormally high FM100 Hue scores. All control subjects passed all the colour vision tests. The D-15 test showed that 28 per cent (26 of 93) of exposed employees had a colour vision defect whereas the FM 100 Hue test found that 63 per cent (59 of 93) had a colour vision defect. Most defects were of the blue-yellow type (22.6 per cent) when using the D-15 test. However, with the FM 100 Hue test, most defects were of the non-polar type with no specific axis (50.5 per cent). Mean total error scores calculated from the FM100 Hue test for exposed employees were statistically significantly higher than those of the control subjects.

CONCLUSION

Employees directly exposed to petroleum derivatives and solvents have a higher risk of acquiring colour vision defects compared to subjects who are not.

Volatile organic compounds inhibit human and rat neuronal nicotinic acetylcholine receptors expressed in Xenopus oocytes

The relative sensitivity of rats and humans to volatile organic compounds (VOCs) such as toluene (TOL) and perchloroethylene (PERC) is unknown and adds to uncertainty in assessing risks for human exposures to VOCs. Recent studies have suggested that ion channels, including nicotinic acetylcholine receptors (nAChRs), are targets of TOL effects. However, studies comparing TOL effects on human and rat ligand-gated ion channels have not been conducted. To examine potential toxicodynamic differences between these species, the sensitivity of human and rat nAChRs to TOL was assessed. Since PERC has similar effects, in vivo, to TOL, effects of PERC on nAChR function were also examined. Two-electrode voltage-clamp techniques were utilized to measure acetylcholine-induced currents in neuronal nAChRs (alpha4beta2, alpha3beta2, and alpha7) expressed in Xenopus oocytes. PERC (0.065 mM) inhibited alpha7 nAChR currents by 60.1 +/- 4.0% (human, n = 7) and 40 +/- 3.5% (rat, n = 5), and inhibited alpha4beta2 nAChR currents by 42.0 +/- 5.2% (human, n = 6) and 52.2 +/- 5.5% (rat, n = 8). Likewise, alpha3beta2 nAChRs were significantly inhibited by 62.2 +/- 3.8% (human, n = 7) and 62.4 +/- 4.3% (rat, n = 8) in the presence of 0.065 mM PERC. TOL also inhibited both rat and human alpha7, alpha4beta2, and alpha3beta2 nAChRs. Statistical analysis indicated that although there was not a species (human vs. rat) difference with PERC (0.0015-0.065 mM) or TOL (0.03-0.9 mM) inhibition of alpha7, alpha4beta2, or alpha3beta2 nAChRs, all receptor types were more sensitive to PERC than TOL. These results demonstrate that human and rat nACh receptors represent a sensitive target for VOCs. This toxicodynamic information will help decrease the uncertainty associated with animal to human extrapolations in the risk assessment of VOCs.

Impairments of Colour Vision Induced by Organic Solvents: A Meta-Analysis Study

The impairment of colour discrimination induced by occupational exposure to toluene, styrene and mixtures of organic solvents is reviewed and analysed using a meta-analytical approach. Thirty-nine studies were surveyed covering a wide range of exposure conditions. Those studies using the Lanthony Panel D-15 desaturated test (D-15d) were further considered. From these for 15 samples data on colour discrimination ability (Colour Confusion Index, CCI) and exposure levels were provided, required for the meta-analysis. In accordance with previously reported higher CCI values for the exposed groups, the computations yielded positive effect sizes for 13 of the 15 samples, indicating that in the great majority of the studies the exposed groups showed inferior colour discrimination. However, the meta-analysis showed great variation in effect sizes across the studies. Possible reasons for inconsistency among the reported findings are discussed. These pertain to exposure-related parameters, as well as to confounders such as conditions of test administration and characteristics of subject samples. Those factors vary considerably among the studies and might have greatly contributed to divergence in measured colour vision capacity, thereby obscuring consistent effects of organic solvents on colour discrimination.

Colour vision and occupational toluene exposure: results of repeated examinations

Potential effects of human occupational exposures to toluene on colour vision were investigated in a follow-up study over 4 years with three repeated examinations. Colour vision was measured with the Lanthony desaturated colour vision test D-15d, and the colour confusion index (CCI) was calculated. The mean current exposures were 26+/-21 ppm for printers (high toluene level) and 3+/-4 ppm for end-processors (low toluene level). The mean exposure durations were 23+/-6 years for "long-time exposed" and 7+/-2 years for "short-time exposed" subjects. Repeated analyses (n=162) and multiple regressions (maximum available n=267) did not reveal significant effects of toluene with respect to intensity or duration of current or long-term exposure. Age and occupational qualification were significantly associated with CCI in both kinds of analysis, whereas alcohol consumption (carbohydrate-deficient transferrin, CDT) and smoking habits (cigarettes per day) were not. It is concluded that current industrial exposure limits of toluene provide sufficient protection against possible disturbance of colour vision.

Neurotoxic effects of organic solvents among workers in paint and lacquer manufacturing industry

Introduction Organic solvents are chemically different compounds with one common feature: they dissolve fats, oils, resins, cellulose acetate and cellulose nitrate, which makes them widely used in industry. Most often organic solvents are used in paint and lacquer industries, in production of pesticides, plastics, explosives, rubber, cellulose, air conditioners, in pharmaceutical industry and in leather industry. The aim of this research was to analyze the working environment and professional hazards in paint and lacquer manufacturing industry and evaluate effects of chronic exposure to mixture of organic solvents on nervous system of exposed workers. Methodology The exposed group consisted of 50 workers professionally exposed to these noxae, while the control group consisted of 30 workers who have never been exposed to these noxae. Results Examination of working environment in departments of paint and lacquer manufacturing revealed presence of white spirit and toluene above allowed levels. Exposed workers more frequently complained of fatigue, hand numbness, enhanced excitation, and concentration difficulties, forgetfulness and headaches, than workers from the control group. Electroneurographic examination of n. medianus showed reduced motor and sensitive conduction velocity among exposed in comparison to workers from the control group. Reduced motor and sensitive conduction velocity was correlated with duration of exposure to these noxae. Terminal latency of n. medianus was statistically, significantly longer in the exposed group than in the control group. Workers in the exposed group have statistically significantly longer reaction time in response to acoustic and visual stimuli. Discussion Segmental demyelination and axonal degeneration, as forms of damage to peripheral nerves, were identified as responsible for peripheral neuropathy associated with occupational exposure to organic solvents. Conclusion Results of this study show possible neurotoxic effects of noxae detected in the phase of analysis of working conditions and working environment of examined workers.

Does Occupational Exposure to Organic Solvents Affect Colour Discrimination?

This review assesses the evidence regarding the effects of occupational exposure to organic solvents on colour discrimination and investigates exposure-response relationships and reversibility. This review also considers the current state of knowledge of the possible mechanisms underlying changes in colour vision, and the human health significance of any reported changes. Among the commonly used organic solvents, styrene has been investigated the most thoroughly. Studies of styrene-exposed workers in Germany, Italy and Japan provide a sufficiently consistent body of evidence to support a robust conclusion that styrene does cause an impairment of colour discrimination relative to age-matched controls. Generally, the impairment of colour discrimination observed in styrene-exposed workers tends to be of the tritan (blue-yellow) type, although some cases of red-green impairment have also been found. The limited information available on exposure-response relationships indicates that the effects on colour discrimination would not be expected at 8-hour time weighted average (8 h TWA) exposures <20 ppm, although a precise threshold cannot be determined. The data on reversibility are limited and inconclusive. The results from the most rigorous study in which this aspect was investigated point to a reversibility of effects after a 4-week exposure-free period, whereas results from a study with limitations suggest a persistence of effect. The effects of toluene, tetrachloroethylene or mixed solvent exposure have also been investigated, although the information available is generally less reliable than for styrene. For toluene, it can be confidently concluded that this solvent does not have an acute effect on colour discrimination, even when exposures are relatively high (50-150 ppm 8 h TWA, and 290-360 ppm 30 minutes TWA). However, studies are inconclusive on whether long-term or repeated exposure to toluene can cause a persistent impairment of colour discrimination. There are few studies that have specifically investigated the effects of tetrachloroethylene on colour discrimination. Among these studies, none has examined the potential for any acute effects of this solvent vapour. A large-scale study in Japanese workers showed no effects of long-term exposure to tetrachloroethylene concentrations in the region of 12-13 ppm. However, the test methodology used was relatively insensitive to changes in colour discrimination, hence the results do not provide reassurance for an absence of subtle effects. A study in Italian dry-cleaners suggested a slight impairment of colour discrimination relative to controls, associated with relatively low exposures to tetrachloroethylene (mean 8 h TWA exposure approximately 6 ppm). The studies concerning the effects of mixed solvent exposure on colour discrimination are based on workers exposed to solvents in paints and lacquers, workers from the printing and petrochemical industries, people working in or living near to microelectronics factories and children exposed to solvents prenatally. However, these studies are subject to design limitations or methodological irregularities, such that no conclusions regarding the effects of mixed solvent exposure on colour discrimination can be drawn. Overall, the only credible evidence for an effect of solvents on colour discrimination derives from the studies on styrene. Because of limitations in the data for other solvents it is not possible to determine whether the evidence for styrene reflects a generic property of solvents. The mechanisms of styrene-induced effects on colour discrimination have not been properly investigated and can only be the subject of speculation. One conclusion that can be drawn is that pathological changes to the ocular system, such as changes to the lens, are unlikely to be involved. This is because there is an absence of convincing evidence for such changes from medical examinations conducted in epidemiological studies of solvent-exposed workers. Also, it seems unlikely that effects on colour discrimination are a nonspecific consequence of more generalised CNS depression, given that styrene-induced effects on colour discrimination appear to occur below the threshold for narcotic effects. The effects of styrene on colour discrimination are subtle and involve an impairment of the ability to discriminate accurately between closely related shades of the same colour rather than 'colour blindness'. There is no valid basis for using colour discrimination as a marker for other forms of solvent-induced neurotoxicity.

Color vision impairment in workers exposed to neurotoxic chemicals

Recent research shows that occupational exposure to several solvents, metals and other industrial chemicals can impair color vision in exposed workers. Occupation-related color vision impairment usually results in blue-yellow color discrimination loss or, less frequently, a combination of blue-yellow and red-green loss. The eyes may be unequally involved, and the course is variable depending on exposure and other factors. The pathogenesis of occupational color vision loss has not been elucidated; it may be due to, e.g. a direct action of neurotoxins on receptors, possibly on the cone's membrane metabolism, and/or to an interference with neurotransmitters within the retina. Other possible pathogenetic mechanisms, such as a direct effect to the optic nerve, have also been suggested. Occupational color vision loss is usually sub-clinical, and workers are unaware of any deficit. It can be assessed using sensitive tests, such as the Farnsworth-Munsell 100 Hue (FM-100) or the Lanthony D-15 desaturated panel (D-15 d). The latter is the most widely used for studies in groups of exposed workers, and offers the possibility of a quantitative evaluation of the results by calculation of the Bowman's Color Confusion Index (CCI), or of the Vingrys' and King Smith's Confusion Index (CI). Other advantages of D-15 d are the possibility to perform the test directly at the workplace, and the reproducibility when performed in standardized conditions. In most cases, occupation-related color vision impairment is correlated to exposure levels, and has often been observed in workers exposed to environmental concentrations below the current occupational limit proposed by the ACGIH. Progression with increasing cumulative exposure has been reported, while reversibility is still discussed. Acquired color vision impairment related to occupational exposure to styrene, perchloroethylene (PCE), toluene, carbon disulfide, n-hexane, solvent mixtures, mercury and some other chemicals are discussed. Results show that color vision testing should be included in the evaluation of early neurotoxicity of chemicals in exposed workers. The D-15 d would be useful in the surveillance of workers exposed to solvents and other chemicals toxic to the visual system.

Occupational exposure to chemicals and sensory organs: a neglected research field

The effect of industrial chemicals on the sensory perception of exposed workers has received scant attention from the medical community to date, and the scientific literature is mainly limited to some case-reports or isolated studies. Possible explanations for this include the complexity of sensory perception, and the lack of agreement among researchers on methods for testing large groups of subjects. Nevertheless, some published studies showed that vision, hearing and olfactory function can be affected by various industrial metals and solvents, and some data exist also for touch and taste. This review discusses the main industrial chemicals involved. The pathogenesis of the toxicity of chemicals to sensory perception may be related to an action on receptors, nerve fibers, and/or the brain; probably, different pathogenetic mechanisms are involved. One of the main problems in this research field is that most of the studies to date evaluated the effect of a single industrial chemical on a single sense: as an example, we know that styrene exposure can impair smell and also hearing and vision but we have little idea whether different senses are impaired in the same worker, or whether each impairment is independent. In addition, workers are frequently exposed to different chemicals: co-exposure may have no effect, or result in both an increase or a decrease of the effect, as was observed for hearing loss, but studies on this aspect are largely insufficient. Research shows that both occupational and environmental exposure to industrial chemicals can affect sense organs, and suggests that the decline of perception with age may be, at least partly, related to this exposure. Nevertheless, available evidence is incomplete, and is largely inadequate for an estimation of a "safe" threshold of exposure. Good quality further research in this field is needed. This is certainly complex and demands adequate resources, but is justified by the ultimate result: the possibility to prevent an avoidable part of the decline in sensory function with age.

Visual dysfunction in retinal and optic nerve disease

Visual perceptions seen with retinal and optic nerve disease may overlap with those resulting from retrochiasmal disorders. A few disorders typically present with distinctive perceptions, but the majority have less specific symptoms. Features include whether or not the visual phenomena are negative or positive, monocular or binocular, and the location and form of any deficits. Among negative phenomena, transient visual loss usually is the result of ischemic disease, but particular precipitants may suggest demyelination or photoreceptor degeneration. The pattern and location of visual field defects may help localize disorders to the level of the macula, papillomacular or other inner retina nerve fiber bundles, optic nerve, or chiasm. Altered brightness perception may point to optic nerve or photoreceptor disease. Decreased acuity is among the most common and least specific symptoms, but association with other symptoms may help to narrow the differential diagnosis. Dyschromatopsia points to either a photoreceptor or optic nerve pathologic condition (Table 7). Among positive phenomena, hallucinations resulting from anterior visual system disorders typically are unformed, although deafferentation of retrochiasmal pathways may produce formed hallucinations. The common "floaters" frequently are benign, but occasionally herald more concerning disorders. Various types of photopsias commonly occur with vitreal disorders or photoreceptor disorders. Macular disease typically leads to distortions of the central visual field, and other particular disorders lead to a host of characteristic distortions of color, form, or brightness. Careful attention to the ophthalmologic examination, visual fields, and subtle variance in symptomatology also help to distinguish among various disorders.

Influence of occupational exposure to organic solvent mixtures on contrast sensitivity in printers

Contrast sensitivity measurement accurately evaluates the sensitivity of all human visual channels, even in a more detailed manner than simple acuity measures can. This is a study of visual contrast sensitivity in a series of subjects occupationally exposed to organic solvents. Contrast sensitivity was measured for 42 printers and 28 age-stratified controls using the Vistech VCTS 6500 chart. The exposed workers distinguished between following three groups of printers: "low exposed," "middle exposed," and "high exposed." Abnormal contrast sensitivity results were recorded for the right eye in 38% of the printers and 11% of the controls and for the left eye in 38% of the printers and 7% of the controls. Especially, we found a reduced contrast sensitivity in all three groups exposed to solvents for both eyes. We conclude that contrast sensitivity is abnormal in workers exposed to organic solvents. The reduced contrast sensitivity in printers seems to be an indicator of visual defects induced in response to organic solvents exposure.

Color vision and occupational chemical exposures: I. An overview of tests and effects

The paper presents a summary of the literature published until December 2000 on effects from some industrial chemical exposures on color perception, as well as short descriptions of the tests applied. Several different tests have been used to study acquired alterations of color vision. These changes are frequently found in the blue-yellow axis. Many of the tests were originally designed to detect congenital alterations in the red-green axis, and thus have relatively low sensitivity when studying chemically induced deficits in color perception. At present, the Lanthony D15-desaturated panel seems most suitable for application in industrial settings, since it is clearly the most sensitive and easily administered test. Color vision seems to be a physiological function very sensitive to several chemicals. The potency of industrial chemicals to induce color vision deficiencies has often been investigated during the last two decades. The chemicals most frequently studied are different solvents and mercury. Pronounced effects on color perception have been reported following chronic exposure to organic solvents such as styrene, carbon disulphide, perchloroethylene, n-hexane and solvent mixtures, and to organic as well as inorganic mercury. The effect of occupational toluene exposure seems not as well established, since only slight effects and several negative studies have been reported. For some of these compounds the effect on color vision has been further established through the finding of clear dose-effect relationships. In a few cases, even acute exposure situations, e.g. exposure to toluene for a few hours or acute alcohol intake, seem to affect color perception. Follow-up studies are needed to investigate the possible reversibility of effects in relation to discontinued or reduced exposures.

Concordance across species in the reproductive and developmental toxicity of tetrachloroethylene

Reproductive and developmental toxicities resulting from exposure to tetrachloroethylene include delayed or impaired conception, sperm quality, death during development, developmental neurotoxicity, and growth retardation. In most cases there was concordance between rodents and humans. The risk assessments indicated that neurotoxicity was the most sensitive endpoint for inhalation, whereas growth retardation was the most sensitive endpoint when exposure was by the oral route. The reference concentration (RfC) of 0.01 ppm was based on neurotoxicity among human subjects. The reference dose (RfD) of 0.0006 mg/kg per day was based on small for gestation age infants. In both cases, studies in rodents supported the credibility of these assessments. For the RfD, similar findings for other trihalomethanes have been reported. The latter part of pregnancy and early life may constitute a susceptible period for alterations leading to behavioral deficits. During this period, the capacity to metabolize tetrachloroethylene is reduced and may further contribute to the sensitivity during this phase of development. Studies suggest that an effect on dopamine metabolism is a plausible mode of action for some types of neurotoxicity. In addition, it has been suggested that this alteration may affect reproductive integrity by influencing prolactin levels.

Color vision and occupational toluene exposure

We examined the relationship between acquired color vision loss and exposure to toluene and total hydrocarbons among 125 male workers. Seventy-two toluene-exposed printers were compared with 34 workers from the same photogravure plant with ambient background exposure, and with 19 workers from a bookbinding plant located in the same town (nonexposed). Environmental mean toluene exposure level at workstation was estimated from individual 8-h sampling. Historic exposure data from the last 30 years were used to construct two cumulative exposure indices, one for toluene and one for total hydrocarbons. Airborne toluene levels were overall lower than the current Threshold Limit Value (TLV) of 50 ppm. Color vision was assessed by the Lanthony D-15 desaturated panel. Color vision loss was quantitatively established by the Color Confusion Index (CCI) and classified by type of acquired dyschromatopsia according to Verriest's classification. CCI was positively related to current airborne toluene levels, and cumulative exposure indices for toluene and total hydrocarbons (.18< or =r< or =.35). Odds ratios of acquired dyschromatopsia were significant for current airborne toluene, toluene, and total hydrocarbon past exposure (1.27 [1.02-1.58], 1.21 [1.04-1.39], 1.15 [1.02-1.31], respectively). In conclusion, this study suggests that the Lanthony D-15 desaturated panel detects early neurotoxic effects among workers exposed to toluene.