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Severity of acute ocular involvement is independently associated with time to resolution of ocular disease in toxic epidermal necrolysis patients
  1. Jacob S Heng1,2,3,
  2. Nabeel Malik3,
  3. Naresh Joshi3,
  4. Michelle Hayes1,
  5. Isabel Jones4,
  6. L Claire Fuller5,
  7. Marcela P Vizcaychipi1,2
  1. 1Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK
  2. 2Faculty of Medicine, Imperial College, London, UK
  3. 3Department of Ophthalmology, Chelsea and Westminster Hospital, London, UK
  4. 4Burns Service, Chelsea and Westminster Hospital, London, UK
  5. 5Department of Dermatology, Chelsea and Westminster Hospital, London, UK
  1. Correspondence to Dr Marcela P Vizcaychipi, Chelsea and Westminster Hospital, Faculty of Medicine, Department of Surgery and Cancer, Imperial College London, 369 Fulham Road, London SW10 9NH, UK; m.vizcaychipi{at}imperial.ac.uk

Abstract

Purpose Toxic epidermal necrolysis (TEN) is a severe, life-threatening mucocutaneous disorder that frequently involves the ocular surface. This study aims to investigate the natural history and resolution of acute ocular involvement in patients with TEN admitted to the intensive care unit (ICU).

Methods Case notes of patients admitted to ICU with TEN at a tertiary referral centre in a 9-year period were retrospectively reviewed. Patients’ characteristics, severity of ocular involvement, SCORTEN systemic severity score and treatment were correlated with resolution of ocular involvement and time to resolution.

Results Nine out of 10 (90%) patients had ocular involvement with 4 graded as mild, 2 as moderate and 3 as severe. All had bilateral ocular disease. The median length of hospital stay was 28 days and the median time to resolution of ocular involvement was 19 days. Four out of 9 (44%) patients still had active ocular disease at the time of discharge. Only older age (p=0.032) and a milder grade of ocular disease (p=0.001) were significantly associated with resolution of ocular disease. In a multivariable Cox-regression model, only a milder grade of ocular disease remained independently associated with time to resolution of ocular disease (p=0.006).

Conclusions Grading of acute ocular disease severity does not reflect systemic disease severity and is significantly associated with resolution and time to resolution of ocular involvement in TEN. The high rate of ocular involvement in patients with TEN and relatively large proportion of patients with active disease on discharge reiterates the need for constant ophthalmological monitoring of these patients.

  • Ocular surface
  • Immunology
  • Inflammation
  • Conjunctiva
  • Cornea

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