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.
- Stevens Johnson syndrome
- Toxic Epidermal Necrolysis