Ophthalmic Manifestations of Toxic Epidermal Necrosis Syndrome and Stevens–Johnson Syndrome: A Five Year Retrospective Review

Abstract

Abstract: : Purpose: To characterize the ophthalmic manifestations of a series of patients with Toxic Epidermal Necrosis Syndrome (TENS) and Stevens–Johnson Sy Methods: Retrospective review of the records of patients admitted to the burn unit of the NY Presbyterian Hospital with the diagnosis of TENS or SJS between July 1999 and June 2004. Only patients seen by the ophthalmology consult service were included. Results: Of the 42 patients admitted to the burn unit with the diagnosis of TENS or SJS during this period, 29 patients with 58 eyes were identified that met our inclusion criteria. There were 59% women and 41% men whose ages ranged from 5 months to 77 years. 24% of cases were HIV positive while 28% had a history of underlying malignancy. The mean total body surface area slough was 43% with a range from 10 to 95%. Of the 93% of patients with ophthalmic findings, 100% had eyelid involvement and 93% had all four eyelids affected. Symblepharon was seen initially or developed subsequently in 33% of patients and 28% of eyelids. SPK was seen in 67% of patients involving 67% of eyes. Corneal abrasions were observed in 56% of patients involving 43% of eyes. A corneal ulcer developed in one eye of one patient and ultimately progressed to corneal perforation requiring treatment with corneal glue and patch grafting. 44% of patients were intubated and sedated when initially evaluated by the ophthalmology service. Initial visual acuity by near card was obtained in 56% of patients and 48% of eyes and ranged from 20/20 to fix and follow with an average visual acuity of 20/77. A final visual acuity was obtained in 74% of patients with a mean visual acuity at the time of the last ophthalmology consult of 20/59. Conclusions: Ocular involvement is common in patients with TENS and SJS. Ophthalmologists should work closely with the burn unit since early and frequent ophthalmic evaluation is important for the diagnosis and treatment of potentially vision threatening complications.

Keywords: inflammation • anterior segment • antibiotics/antifungals/antiparasitics