Severe Dry Eye With Combined Mechanisms is Involved in the Ocular Sequelae of SJS/TEN at the Chronic Stage

Sotozono, Chie; Ueta, Mayumi; Yokoi, Norihiko

doi:10.1167/iovs.18-24019

Cited by 36 publications

(23 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The use of artificial tears with high wetting power and no preservatives and vitamin A eye ointment seems to be strongly recommended. Lubricating the eye is vital to maintain and improve tear film quality [ 22 ]. Nonetheless, the interest of using artificial tears in the acute phase has not been supported by solid evidence.…”

Section: Discussionmentioning

confidence: 99%

Management of ocular involvement in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis: french national audit of practices, literature review, and consensus agreement

Thorel

Ingen‐Housz‐Oro

Royer

et al. 2020

Orphanet J Rare Dis

View full text Add to dashboard Cite

Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) can lead to severe ophthalmologic sequelae. The main risk factor is the severity of the initial ocular involvement. There are no recommendations for ocular management during acute phase. We conducted a national audit of current practice in the 11 sites of the French reference center for toxic bullous dermatoses and a review of the literature to establish therapeutic consensus guidelines. We sent a questionnaire on ocular management practices in SJS/ TEN during acute phase to ophthalmologists and dermatologists. The survey focused on ophthalmologist opinion, pseudomembrane removal, topical ocular treatment (i.e. corticosteroids, antibiotics, antiseptics, artificial tear eye drops, vitamin A ointment application), amniotic membrane transplantation, symblepharon ring use, and systemic corticosteroid therapy for ophthalmologic indication. Nine of 11 centers responded. All requested prompt ophthalmologist consultation. The majority performed pseudomembrane removal, used artificial tears, and vitamin A ointment (8/9, 90%). Combined antibiotic-corticosteroid or corticosteroid eye drops were used in 6 centers (67%), antibiotics alone and antiseptics in 3 centers (33%). Symblepharon ring was used in 5 centers (55%) if necessary. Amniotic membrane transplantation was never performed systematically and only according to the clinical course. Systemic corticosteroid therapy was occasionally used (3/9, 33%) and discussed on a case-by-case basis. The literature about ocular management practice in SJS/ TEN during acute phase is relatively poor. The role of specific treatments such as local or systemic corticosteroid therapy is not consensual. The use of preservatives, often present in eye drops and deleterious to the ocular surface, is to be restricted. Early amniotic membrane transplantation seems to be promising.

show abstract

Section: Discussionmentioning

confidence: 99%

Management of ocular involvement in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis: french national audit of practices, literature review, and consensus agreement

Thorel

Ingen‐Housz‐Oro

Royer

et al. 2020

Orphanet J Rare Dis

View full text Add to dashboard Cite

show abstract

“…Tissue changes can be a causal factor of chronic pain in SJS/TEN patients, as is the case for severe eye dryness 23 . Thus, it is conceivable that changes in nociceptive free endings secondary to epidermal repair are involved in the persistence of painful phenomena.…”

Section: Discussionmentioning

confidence: 99%

Chronic pain: a long‐term sequela of epidermal necrolysis (Stevens–Johnson syndrome/toxic epidermal necrolysis) – prevalence, clinical characteristics and risk factors

Lefaucheur

Valeyrie‐Allanore

Tin

et al. 2020

Acad Dermatol Venereol

View full text Add to dashboard Cite

BackgroundStevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are associated with various sequelae. Chronic pain, one of these sequelae, has never been systematically evaluated.Objectives and methodsTo assess the persistence of pain in a single‐centre cohort of 113 consecutive patients with SJS/TEN. From this cohort, 81 patients were interviewed more than 1 year after the initial episode and included in the study. Data were collected according to standardized questionnaires.ResultsFrom the 81 interviewed patients, 52 patients (64%) were painless and 29 patients (36%) were painful. Chronic pain syndrome was associated with a more severe initial acute phase of the disease (larger extent of detachment, higher SCORTEN, increased rate of admission in ICU and complications, and longer hospital stay). Pain was mainly located at the level of eyes (55%), mouth and lower limbs (38–41%), with a moderate daily intensity on average (4.7/10). The ‘affective’ descriptors prevailed over the ‘sensory’ descriptors, with the exception of burning and itching sensations. Finally, regarding provoked pain, mechanical allodynia (to brushing and pressure) was more marked than thermal allodynia.DiscussionThe persistence of chronic pain after SJS/TEN is a common phenomenon. Sensory descriptors are consistent with sensitization of both small‐diameter nerve fibres (burning and itching sensations) and large‐diameter nerve fibres (mechanical allodynia), but the affective‐emotional components of pain largely predominate.ConclusionsComplex mechanisms lead to persistent pain as long‐term sequela of SJS/TEN, among which mechanisms, psychological factors related to post‐traumatic stress disorder probably play a key role.

show abstract

“…trichiasis). As trichiasis and eye dryness are triggers themselves for conjunctival inflammation, a self‐enhancing process has constituted involving persistent conjunctival inflammation 158,159 . The role of inflammation in ocular sequelae is emphasized by the finding that HIV patients show less severe ocular involvement 160 …”

Section: Disease Sequelaementioning

confidence: 99%

“…To improve eye dryness, artificial tears, occlusion of the tear drainage duct and smaller scleral contact lenses can be applied. Oral mucous membrane transplantations might be required to treat conjunctival sequelae, whereas eye lash depilation is used to treat trichiasis 11,159 …”

Section: Disease Sequelaementioning

confidence: 99%

Clinical and pathogenic aspects of the severe cutaneous adverse reaction epidermal necrolysis (EN)

Kuijper

French

Tensen

et al. 2020

Acad Dermatol Venereol

View full text Add to dashboard Cite

The severe cutaneous adverse reaction epidermal necrolysis (EN) which includes toxic epidermal necrolysis and the milder Stevens‐Johnson syndrome is characterized by epidermal loss due to massive keratinocyte apoptosis and/or necroptosis. EN is often caused by a drug mediating a specific TCR‐HLA interaction via the (pro)hapten, pharmacological interaction or altered peptide loading mechanism involving a self‐peptide presented by keratinocytes. (Memory) CD8 + T cells are activated and exhibit cytotoxicity against keratinocytes via the perforin/granzyme B and granulysin pathway and Fas/FasL interaction. Alternatively drug‐induced annexin release by CD14 + monocytes can induce formyl peptide receptor 1 death of keratinocytes by necroptosis. Subsequent keratinocyte death stimulates local inflammation, activating other immune cells producing pro‐inflammatory molecules and downregulating regulatory T cells. Widespread epidermal necrolysis and inflammation can induce life‐threatening systemic effects, leading to high mortality rates. Research into genetic susceptibility aims to identify risk factors for eventual prevention of EN. Specific HLA class I alleles show the strongest association with EN, but risk variants have also been identified in genes involved in drug metabolism, cellular drug uptake, peptide presentation and function of CD8 + T cells and other immune cells involved in cytotoxic responses. After the acute phase of EN, long‐term symptoms can remain or arise mainly affecting the skin and eyes. Mucosal sequelae are characterized by occlusions and strictures due to adherence of denuded surfaces and fibrosis following mucosal inflammation. In addition, systemic pathology can cause acute and chronic hepatic and renal symptoms. EN has a large psychological impact and strongly affects health‐related quality of life among EN survivors.

show abstract

Severe Dry Eye With Combined Mechanisms is Involved in the Ocular Sequelae of SJS/TEN at the Chronic Stage

Abstract: Severe dry eye with combined mechanisms is involved in the ocular sequelae of SJS/TEN at the chronic stage.

Cited by 36 publications

References 44 publications

Management of ocular involvement in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis: french national audit of practices, literature review, and consensus agreement

Management of ocular involvement in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis: french national audit of practices, literature review, and consensus agreement

Chronic pain: a long‐term sequela of epidermal necrolysis (Stevens–Johnson syndrome/toxic epidermal necrolysis) – prevalence, clinical characteristics and risk factors

Clinical and pathogenic aspects of the severe cutaneous adverse reaction epidermal necrolysis (EN)

Contact Info

Product

Resources

About