SCIENTIFIC REPORT

Early pathological features of the cornea in toxic epidermal necrolysis

G P Williams¹, H S Mudhar² and M Leyland¹

¹ Department of Ophthalmology, Royal Berkshire NHS Foundation Trust, Reading, Berkshire
² Department of Histopathology, Royal Hallamshire Hospital NHS Foundation Trust, Sheffield

Correspondence to:
G P Williams, Department of Ophthalmology, University Hospital Birmingham, Selly Oak Hospital, Raddlebarn Road, Birmingham B29 6JD; gpwilliams{at}doctors.net.uk

Aim: To describe the early pathological changes in the cornea during toxic epidermal necrolysis (TEN).

Method: Demonstration of histological features of sequential corneal samples taken during management of complications of TEN in a young adult.

Results: Early vacuolation of basal keratinocytes and late infiltration of the cornea with CD 8 lymphocytes were observed. These changes are similar to those found in cutaneous TEN and may represent weakening of the stromal–epithelium interface with resultant recurrent erosion and chronic inflammation.

Conclusions: Similar changes were found in avascular corneal tissue to those previously described in skin. The initial insult may be traumatic. We propose that a cytokine-mediated response contributes to the initial insult, either in response to and/or by accelerating severe inflammation. This precedes a cytotoxic infiltration which may exacerbate episodes of recurrent erosion. This provides a new insight into the mechanism of disease in the cornea following TEN.

Abbreviations: AMG, amniotic membrane grafting; IL1, interleukin 1; MMP, matrix metalloproteinases; SJS, Stevens-Johnson syndrome; TEN, toxic epidermal necrolysis

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