Plasmapheresis and autologous serum eye‐drops in the treatment of acute ocular complications from toxic epidermal necrolysis (Lyell syndrome)

Abstract

AbstractPurpose Toxic epidermal necrolysis (TEN) is a rare, life‐threatening, drug‐induced, mucocutaneous disease, which can affect the ocular surface. The purpose of this study was to evaluate the acute ocular complications from TEN and investigate on the efficacy of plasmapheresis and serum‐eyedrops in the treatment of this condition.Methods A retrospective chart review of all Burn Unit patients admitted from 2009‐2013 identified 7 TEN patients (2 men, 5 women; mean age: 69.6±20.3 years). TEN was associated with allopurinol use in 4 patients, with gefitinib in 1, and with trimethoprim/sulphamethoxazole in 1. In the remaining patient, the causative agent was not identified. Acute bilateral ocular complications were observed in 5 patients; 3 showed mild ocular surface inflammation, whereas 2 had severe pseudomembranous conjunctivitis with corneal ulcers. All TEN patients were immediately treated with plasmapheresis.Results In the 2‐3 weeks after plasmapheresis, there was a marked improvement of the patients' general condition. In those with mild ocular surface inflammation, the use of preservative‐free artificial tears and steroids was beneficial. In the 2 with pseudomembranous conjunctivitis and corneal ulcers, treatment with autologous serum eye‐drops and preservative‐free artificial tears was effective, resulting in corneal epithelium healing and mild conjunctival scarring.Conclusion Not all TEN patients have ocular complications at onset. Plasmapheresis may be life‐saving and contribute to reduce ocular surface inflammation. Autologous serum eye‐drops prepared after plasmaferesis may be helpful in the management of the acute ocular complications caused by TEN.