Early pathological features of the cornea in Toxic Epidermal Necrolysis
Abstract
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.
Stevens‐Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, life‐threatening mucocutaneous blistering disorders. TEN is the more severe manifestation with a mortality rate of 34%.1 The immunological pathogenesis has been previously reported in the skin.2,3,4,5,6 There are few pathological data regarding the early corneal changes, however. We report the histological features of sequential corneal samples taken during management of complications of TEN in a young adult.