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 28â days and the median time to resolution of ocular involvement was 19â 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.
Subject(s)
Conjunctival Diseases/physiopathology , Corneal Diseases/physiopathology , Eyelid Diseases/physiopathology , Severity of Illness Index , Stevens-Johnson Syndrome/physiopathology , Acute Disease , Adult , Aged , Anti-Bacterial Agents/administration & dosage , Conjunctival Diseases/classification , Conjunctival Diseases/drug therapy , Corneal Diseases/classification , Corneal Diseases/drug therapy , Eyelid Diseases/classification , Eyelid Diseases/drug therapy , Female , Glucocorticoids/administration & dosage , Humans , Immunoglobulins, Intravenous/administration & dosage , Immunosuppressive Agents/administration & dosage , Intensive Care Units , Length of Stay , Lubricants/administration & dosage , Male , Middle Aged , Retrospective Studies , Stevens-Johnson Syndrome/classification , Stevens-Johnson Syndrome/drug therapy , Young AdultABSTRACT
Sudden onset nonaxial proptosis and diplopia is alarming and orbital haemorrhage or a rapidly expanding orbital tumour should be excluded. We present a case of a young man aged 15 years who attended the Accident and Emergency Department with a 6-h history of sudden onset proptosis and diplopia in whom the aetiology was orbital emphysema.
