Hospital management and clinical factors associated with ophthalmic involvement in toxic epidermal necrolysis

Belinda W Hii; Patrick D Mahar; Jason Wasiak; Anthony J Hall; Eldho Paul; Philip Marsh; Danielle A Buck; Heather Cleland

doi:10.1016/j.burns.2013.10.027

Hospital management and clinical factors associated with ophthalmic involvement in toxic epidermal necrolysis

Burns. 2014 Aug;40(5):903-8. doi: 10.1016/j.burns.2013.10.027. Epub 2013 Nov 26.

Authors

Belinda W Hii¹, Patrick D Mahar², Jason Wasiak³, Anthony J Hall⁴, Eldho Paul⁵, Philip Marsh⁶, Danielle A Buck⁷, Heather Cleland⁸

Affiliations

¹ Department of Plastic, Hand and Faciomaxillary Surgery, The Alfred Hospital, Melbourne, VIC, Australia. Electronic address: belinda.hii@gmail.com.
² Victorian Adult Burns Service, The Alfred Hospital, Melbourne, VIC, Australia; Department of Surgery, School of Medicine, Deakin University, VIC, Australia.
³ Victorian Adult Burns Service, The Alfred Hospital, Melbourne, VIC, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia.
⁴ Department of Ophthalmology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Surgery, Monash University, Melbourne, VIC, Australia.
⁵ Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia.
⁶ Department of Medicine, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia.
⁷ Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.
⁸ Victorian Adult Burns Service, The Alfred Hospital, Melbourne, VIC, Australia; Department of Surgery, Monash University, Melbourne, VIC, Australia.

PMID: 24286611
DOI: 10.1016/j.burns.2013.10.027

Abstract

Background: Toxic Epidermal Necrolysis (TEN) is characterized by an exfoliative rash resembling widespread burns. It is often considered on the same spectrum of disease as Stevens Johnson Syndrome but is distinguished by epidermal detachment of >30% of total body surface area (TBSA). Ocular involvement of TEN may result in complications requiring intensive topical, systemic or operative treatment. This study aimed to identify the current hospital management of, and factors associated with, ophthalmic involvement in adult TEN patients.

Methods: All adult TEN patients admitted to the Victorian Adult Burns Service over an 12-year period were included. Retrospective data analyzed included patient demographics, site of TEN involvement, % TBSA, complications, duration of ocular follow up and visual outcomes.

Results: TEN patients with and without ocular involvement were compared. Cutaneous involvement of the head and neck was found to be significantly associated with ocular involvement of TEN. Age, TBSA involvement, presence of a prodrome, and presence of comorbidities were not found to be significantly associated with ocular involvement. Management of ophthalmic involvement of TEN varied between patients.

Conclusions: Clinicians should have a high index of suspicion for ocular involvement when exfoliation of the head and neck is present and should seek ophthalmological advice early in the course of disease.

Keywords: Ophthalmic involvement; Toxic Epidermal Necrolysis.

MeSH terms

Adult
Aged
Aged, 80 and over
Body Surface Area
Cohort Studies
Dacryocystitis / etiology
Dry Eye Syndromes / etiology
Eye Diseases / etiology
Eye Diseases / therapy*
Female
Head
Hospital Mortality
Humans
Male
Middle Aged
Neck
Prodromal Symptoms
Retrospective Studies
Risk Factors
Stevens-Johnson Syndrome / complications
Stevens-Johnson Syndrome / mortality
Stevens-Johnson Syndrome / therapy*
Trichiasis
Young Adult