25

opia. Also notable was their lack of retinoblasto-

mas, malignant melanomasof the choroid, and

basal cell carcinomaofthe eyelids. Ocular pathology caused by herpes simplex or zoster viruses was
not seen. No cases of retinal detachment occurred
except in two people as a sequela of ocular surgery.
Corneal scars, macular degeneration, vitreous

floaters, and other degenerative intraocular condiuons were seen in about the numbers expected in
anypart of the world. No Toxocara infestation or
otherintraocular parasites have been encountered,
and no ocular involvement by the parasites
Onchocerca orfilaria has been seen. In the one case
of inactive leprosy on Rongelap noocularlesions
have been noted. Some people haveresidual scars
of yaws, but no active lesions have been seen dur-

ing the 20-year period.

Most of the congenital malformations andfa-

milial ocular diseases found in Americans were
not seen in the Marshallese, such as ocular dystro-

phias, retinitis pigmentosa (congenital night blindness), congenital cataracts or glaucoma in the
youngor familial glaucoma in older people, and
colobomaof the iris or posterior segment of the
eye. On the other hand, certain congenital traits
apparentiy peculiar to this race were noted. The
average size of the corneas is greater than in the

U:S., more than 60% of the people examined hav-

ing corneas >>14 mm in diameter. In ~5% of the

people the retinal vessels showed increased tortu-

ositv (corkscrew-like) and dilatation. This phenom-

enon has sometimesbeen found associated with

the sickle cell trait, but the latter has not been

noted in the Marshallese.
Dietetic and hygienic conditions in the Marshall Islands have improved over the 20 years of
this study. In earlier years, poor night vision in
children due to vitamin A deficiency was occasionally found, and molluscum contagiosum was
seen more frequently; also lesions involving the
skin of the eyelids, forehead, and face. It has been
several years since night vision impairment or
molluscum has beenseen.
2. Possible Radiation Effects

Both the detonation in March 1954 andtheresulting fallout gave rise to several types of radiation that might cause injury to the eyes.
Longwave radiation. Direct observation with the
naked eye of the fireball of an atomic bomb detonation is known to produce retinal damage with
scarring and possible blindness.33.34 The Bravo

fireball was observed by a small number of people

on Rongelap,and, thoughits distance from them

precluded thermalinjury to the skin from longwave(visible and infrared) light, injury to the retina must be considered. The fireball was described by the Rongelap people as appearing“like
the sunrising in the west.”’ They probably did not

see it at its greatest luminescence, when the dam-

aging oculareffects occur, because this comes a
fraction of a microsecondafter detonation, so that

at a distance of 100 miles the fireball would not
vet have risen above the horizon. Also, at that dis-

tance the size of the image on the retina would be

small. These factors probably explain why no one

complained of blindness from seeing thefireball

and noretinal scars have been found in anyof the
people.

fonizing radiation. The fallout on Rongelapresulted in a gamma dose of 175 rads to the whole
body including the eyes. Beta rays from fallout

deposited on the ground and contaminating the

eyes resulted in some superficial exposure of the
lids, conjunctiva, and cornea, but their low penetration makes it unlikely that the lens or retina re-

ceived anysignificant dose from this source. Dur-

ing the two days before evacuation, manyofthe

people complained of someitching and burningof
the eyes with some lachrymation. These symptoms
may havebeenrelated to radiation from fallout in
the eyes, but physical and chemicalirritation by
the caustic fallout dust may have played an im-

portant part. Internal absorption of radionuclides
probably did not contribute to the radiation dose
to the eyes.

Conjunctwitis. The burning and lachrymation
disappeared by the time the people were evacuated to Kwajalein Island. However, at the time of
developmentof beta burns, about 2 weeks after exposure, two men developed conjunctivitis and inflammationof the eyelids which may have been
dueto betairradiation. These lesions healed within
several days.
Corneal pigmentatwn. Beginning at about 2 months
post exposure, in some people a pigmented line
was noted in the corneaat the limbusin the horizontal axis of the palpebral fissure, which appeared to be below the surface of the epithelium.
It varied from 0.5 to 2 mm in tength. This may
have been dueto beta radiation and was possibly
related to the bluish pigmentation noted in the
nail beds. The latter disappeared when the nail
bed grew out several monthslater, but the corneal

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