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Br J Ophthalmol doi:10.1136/bjo.2006.113241

Early pathological features of the cornea in Toxic Epidermal Necrolysis.

  1. Geraint P Williams (gpwilliams{at}doctors.org.uk),
  2. Hardeep S Mudhar (hardeep.mudhar{at}sth.nhs.uk),
  3. Martin Leyland (martin.leyland{at}rbbh-tr.nhs.uk)
  1. University Hospital Birmingham, United Kingdom
  2. Royal Hallamshire Hospital NHS Foundation Trust, United Kingdom
  3. Royal Berkshire NHS Foundation Trust,, United Kingdom
    • Published Online First 14 March 2007

    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: We found early vacuolation of basal keratinocytes and late infiltration of the cornea with CD 8 lymphocytes. 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: We have found similar changes 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 in to the mechanism of disease in the cornea following TEN.

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