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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Competing interests: There are no proprietary interests.
amniotic membrane grafting
toxic epidermal necrolysis
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