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Early pathological features of the cornea in toxic epidermal necrolysis
  1. G P Williams1,
  2. H S Mudhar2,
  3. M Leyland1
  1. 1
    Department of Ophthalmology, Royal Berkshire NHS Foundation Trust, Reading, Berkshire
  2. 2
    Department of Histopathology, Royal Hallamshire Hospital NHS Foundation Trust, Sheffield
  1. G P Williams, Department of Ophthalmology, University Hospital Birmingham, Selly Oak Hospital, Raddlebarn Road, Birmingham B29 6JD; gpwilliams{at}doctors.net.uk

Abstract

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.

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Footnotes

  • Competing interests: There are no proprietary interests.

  • Abbreviations:
    AMG

    amniotic membrane grafting

    IL1

    interleukin 1

    MMP

    matrix metalloproteinases

    SJS

    Stevens-Johnson syndrome

    TEN

    toxic epidermal necrolysis

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