title: Severity of acute ocular involvement is independently associated with time to resolution of ocular disease in toxic epidermal necrolysis patients.
abstract: OBJECTIVE
  Toxic epidermal necrolysis (TEN) is a severe, life-threatening mucocutaneous disorder that frequently involves the ocular surface. This study aims to investigate the natural history and resolution of acute ocular involvement in patients with TEN admitted to the intensive care unit (ICU).
  
  
  METHODS
  Case notes of patients admitted to ICU with TEN at a tertiary referral centre in a 9-year period were retrospectively reviewed. Patients' characteristics, severity of ocular involvement, SCORTEN systemic severity score and treatment were correlated with resolution of ocular involvement and time to resolution.
  
  
  RESULTS
  Nine out of 10 (90%) patients had ocular involvement with 4 graded as mild, 2 as moderate and 3 as severe. All had bilateral ocular disease. The median length of hospital stay was 28 days and the median time to resolution of ocular involvement was 19 days. Four out of 9 (44%) patients still had active ocular disease at the time of discharge. Only older age (p=0.032) and a milder grade of ocular disease (p=0.001) were significantly associated with resolution of ocular disease. In a multivariable Cox-regression model, only a milder grade of ocular disease remained independently associated with time to resolution of ocular disease (p=0.006).
  
  
  CONCLUSIONS
  Grading of acute ocular disease severity does not reflect systemic disease severity and is significantly associated with resolution and time to resolution of ocular involvement in TEN. The high rate of ocular involvement in patients with TEN and relatively large proportion of patients with active disease on discharge reiterates the need for constant ophthalmological monitoring of these patients.
authors.affiliation: Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK Faculty of Medicine, Imperial College, London, UK Department of Ophthalmology, Chelsea and Westminster Hospital, London, UK.
authors.forename: Jacob S
authors.initials: JS
authors.lastname: Heng
authors.affiliation: Department of Ophthalmology, Chelsea and Westminster Hospital, London, UK.
authors.forename: Nabeel
authors.initials: N
authors.lastname: Malik
authors.affiliation: Department of Ophthalmology, Chelsea and Westminster Hospital, London, UK.
authors.forename: Naresh
authors.initials: N
authors.lastname: Joshi
authors.affiliation: Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.
authors.forename: Michelle
authors.initials: M
authors.lastname: Hayes
authors.affiliation: Burns Service, Chelsea and Westminster Hospital, London, UK.
authors.forename: Isabel
authors.initials: I
authors.lastname: Jones
authors.affiliation: Department of Dermatology, Chelsea and Westminster Hospital, London, UK.
authors.forename: L Claire
authors.initials: LC
authors.lastname: Fuller
authors.affiliation: Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK Faculty of Medicine, Imperial College, London, UK.
authors.forename: Marcela P
authors.initials: MP
authors.lastname: Vizcaychipi
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003229:Conjunctival Diseases / Q000145:classification / Q000188:drug therapy / Q000503:physiopathology*; D003316:Corneal Diseases / Q000145:classification / Q000188:drug therapy / Q000503:physiopathology*; D005141:Eyelid Diseases / Q000145:classification / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007362:Intensive Care Units; D007902:Length of Stay; D054327:Lubricants / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013262:Stevens-Johnson Syndrome / Q000145:classification / Q000188:drug therapy / Q000503:physiopathology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D054327:Lubricants
keywords: Conjunctiva; Cornea; Immunology; Inflammation; Ocular surface