Erythema Multiforme, Stevens-Johnson Syndrome, and Toxic... : Cornea (original) (raw)

Clinical Science

Erythema Multiforme, Stevens-Johnson Syndrome, and Toxic Epidermal Necrolysis

Acute Ocular Manifestations, Causes, and Management

Chang, Yi-Sheng MD*†; Huang, Fu-Chin MD*; Tseng, Sung-Huei MD*; Hsu, Chao-Kai MD‡; Ho, Chung-Liang MD, PhD§¶; Sheu, Hamm-Ming MD‡

From the *Department of Ophthalmology, †Institute of Clinical Medicine, ‡Department of Dermatology, §Department of Pathology, and ¶Institute of Molecular Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Received for publication December 21, 2005; revision received July 14, 2006; accepted August 29, 2006.

Reprints: Sung-Huei Tseng, Department of Ophthalmology, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, Taiwan (e-mail: [email protected]).

Abstract

Purpose:

To study the acute ocular/cutaneous manifestations, causes, and management of the erythema multiforme (EM)/Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) disease spectrum.

Methods:

We retrospectively reviewed the medical records of all EM/SJS/TEN patients hospitalized at National Cheng Kung University Hospital in Taiwan between 1988 and 2004. Demographic data, medical/medication histories, ocular/mucocutaneous manifestations, management, sequelae, and recurrence were analyzed.

Results:

A total of 207 patients 2 months to 95 years of age were hospitalized with 213 episodes/attacks of EM/SJS/TEN. Medications were the most common cause of any condition: for SJS, carbamazepine was most common; for EM or TEN, allopurinol was most common. In 128 of the 213 attacks (60.1%; 126 patients), ocular manifestations were documented during hospitalization, occurring more often in those with SJS (81.3%) or TEN (66.7%) compared with those with EM (22.7%; P < 0.01). The most frequent ocular treatments were topical steroids, topical antibiotics, and lubricants. Overall, 24 (18.8%) of 128 acute attacks in 126 patients were followed by ocular sequelae, mostly dry eye. Five (2.4%) of the 207 patients sustained a total of 6 recurrent attacks, in 3 cases because of the same medication.

Conclusions:

Ocular manifestations occur in a high proportion of patients with EM/SJS/TEN. The most frequent causes were carbamazepine and allopurinol. A careful medication history should be obtained from these patients. Ophthalmic consultation, evaluation, and management are mandatory.