Ocular toxicity nitrogen mustards

Ocular, percutaneous, inhalation, ingestion, and injection are all possible routes of exposure. Effects may be local, systemic, or both. All of the nitrogen mustards are oily liquids that are colorless to pale yellow and evaporate slowly. They are more dangerous than sulfur mustard but, like sulfur mustard, they are derivatives of ammonia. The most toxic and most volatile of the three nitrogen mustards is HN-2, but HN-3 is used more because it is stable. 

The second exception is that while an antidote is available for systemic effects of Lewisite exposure, there are no antidotes for nitrogen mustard or sulfur mustard toxicity, with one minor caveat if given within minutes after exposure, intravenous sodium thiosulfate may prevent death due to sulfur mustard exposure (25). Otherwise, the medical management for skin, ocular, and respiratory exposure is only supportive. One guideline physicians can follow is to keep skin, eye, and airway lesions free from infection. 

Recognizing the fact that ROS play a role in the pathogenesis of mustard-induced ocular injuries, compounds that inhibit the formation of ROS or prevent their toxic effects would be beneficial in the treatment of mustard-induced ocular injuries. The topical application of low concentrations of Zn/DFO or Ga/DFO after comeal exposure to nitrogen mustards markedly reduced conjunctival, comeal, iris, and anterior chamber injury. In the cornea, the healing of epithehal erosions was faster, the long-term opacification was reduced, and the levels of neovascularization were lowered. In the anterior chamber, decreased inflammation and better maintenance of intraocular pressure were achieved. Cataractous changes were also notably milder (Banin et al., 2003). 

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