Erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis: acute ocular manifestations, causes, and management.
OBJECTIVE
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.
Chang
Yi-Sheng
YS
Department of Ophthalmology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Huang
Fu-Chin
FC
Tseng
Sung-Huei
SH
Hsu
Chao-Kai
CK
Ho
Chung-Liang
CL
Sheu
Hamm-Ming
HM
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004892:Erythema Multiforme / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D005128:Eye Diseases / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology; D013262:Stevens-Johnson Syndrome / Q000150:complications* / Q000188:drug therapy / Q000473:pathology
D000893:Anti-Inflammatory Agents