July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Ocular Histopathology of Acute and Chronic Pediatric Toxic Epidermal Necrolysis
Author Affiliations & Notes
  • Karel D Capek
    Burn, Critical Care, and Reconstruction, Shriners Hospitals for Children, Galveston, Texas, United States
    Surgery, The University of Texas Medical Branch, Galveston, Texas, United States
  • Stefan D Trocmé
    Cornea Consultant, Shriners Hospitals for Children, Galveston, Texas, United States
    Cornea Consultant, MD Anderson Cancer Center, Houston, Texas, United States
  • Hamza Pasha
    Ophthalmology, The University of Texas Medical Branch, Galveston, Texas, United States
  • Humair Khan
    Ophthalmology, The University of Texas Medical Branch, Galveston, Texas, United States
  • Kevin H Merkley
    Ophthalmology, The University of Texas Medical Branch, Galveston, Texas, United States
    Cornea Consultant, Shriners Hospitals for Children, Galveston, Texas, United States
  • Jong O. Lee
    Burn and Critical Care, Shriners Hospitals for Children, Galveston, Texas, United States
    Burn Surgery, The University of Texas Medical Branch, Galveston, Texas, United States
  • Ted Huang
    Burn Reconstruction, Shriners Hospitals for Children, Galveston, Texas, United States
  • David N Herndon
    Chief of Staff, Shriners Hospitals for Children, Galveston, Texas, United States
    Chief of Burns, The University of Texas Medical Branch, Galveston, Texas, United States
  • Hal K Hawkins
    Pathology, Shriners Hospitals for Children, Galveston, Texas, United States
    Pathology, The University of Texas Medical Branch, Galveston, Texas, United States
  • Footnotes
    Commercial Relationships   Karel Capek, None; Stefan Trocmé, None; Hamza Pasha, None; Humair Khan, None; Kevin Merkley, None; Jong Lee, None; Ted Huang, None; David Herndon, None; Hal Hawkins, None
  • Footnotes
    Support  NIH (NIGMS) T32-GM8256
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 162. doi:
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      Karel D Capek, Stefan D Trocmé, Hamza Pasha, Humair Khan, Kevin H Merkley, Jong O. Lee, Ted Huang, David N Herndon, Hal K Hawkins; Ocular Histopathology of Acute and Chronic Pediatric Toxic Epidermal Necrolysis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):162.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Toxic Epidermal Necrolysis (TEN) can lead to devastating vision loss. Treatment of the ocular complications of TEN is predicated upon understanding the alterations of structure and function, and the pathophysiologic drivers thereof. Histopathology can yield powerful insights into all three of the above, but tissue specimens are collected infrequently and there is a time-limited window to observe the active, acute disease process. Here we report a series of 10 patients treated in whom sloughed tissue was submitted for histopathology.

Methods : We identified 10 patients recently treated for TEN for whom acute (<3 months from onset of skin slough) and/or chronic (3 months to 3 years after onset of skin slough) histopathology was available. Demographics and clinical data, including histology slides and pathology reports, were reviewed. Data are presented as average +/- standard error where appropriate.

Results : Twenty-seven specimens were identified from the 10 patients. These included 21 obtained within the acute timeframe and 6 obtained in the chronic timeframe. The acute specimens comprised sloughed tissue from 2 corneae, 8 conjunctivae, 2 mucocutaneous junctions, 6 eyelid outer lamellae excised as part of entropion repair, and 3 explanted amniotic membranes. The specimens obtained within the chronic timeframe included 4 eyelid excisions from entropion repair, 1 conjunctiva, and 1 eyelash line/mucocutaneous junction excision. The average age was 6 +/-1 years. Five of the patients were female. The most striking histopathological findings were loss of conjunctival epithelium in the acute specimens and minimal visualization of elastin fibers with Movat’s stain. This latter unexpected finding was observed in the conjunctival and eyelid excision tissue (Figure 1) and in specimens obtained during both the acute and chronic timeframes. An inflammatory infiltrate was observed in most acute specimens.

Conclusions : These findings provide insight into acute and chronic disease processes responsible for ocular pathology affecting pediatric TEN patients. Particularly the loss of outer eyelid lamellar elastin may explain the tendency of these patients to develop marked entropion. This, coupled with the well-recognized palpebral conjunctival cicatrization provides additive, rather than opposing force vectors that favor inward rotation of the lash line.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

 

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