Early pathological features of the cornea in toxic epidermal necrolysis.
OBJECTIVE
To describe the early pathological changes in the cornea during toxic epidermal necrolysis (TEN).


METHODS
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.
Williams
G P
GP
Department of Ophthalmology, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, UK. gpwilliams@doctors.net.uk
Mudhar
H S
HS
Leyland
M
M
D000328:Adult; D003316:Corneal Diseases / Q000139:chemically induced / Q000276:immunology / Q000473:pathology*; D019573:Epithelium, Corneal / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D015603:Keratinocytes / Q000473:pathology; D008297:Male; D013262:Stevens-Johnson Syndrome / Q000276:immunology / Q000473:pathology*; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology