Early pathological features of the cornea in Toxic Epidermal Necrolysis.
- Geraint P Williams (gpwilliams{at}doctors.org.uk),
- Hardeep S Mudhar (hardeep.mudhar{at}sth.nhs.uk),
- Martin Leyland (martin.leyland{at}rbbh-tr.nhs.uk)
- University Hospital Birmingham, United Kingdom
- Royal Hallamshire Hospital NHS Foundation Trust, United Kingdom
- 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.
