[Ocular complications of Lyell's syndrome: recent concepts apropos of 26 cases]

Abstract

Acute ocular lesions are usual during Toxic Epidermal Necrolysis (T.E.N.) and may induce persistent alterations. These were thought to be of cicatricial nature. 26 patients recovering from TEN had a systematic ophthalmological follow-up of at least six months after the acute stage (mean: 3 years). 11 of 26 patients (42%) exhibited a dry eye, associated in 7 with decreased salivary flow. The sicca syndrome appeared during the acute phase of TEN or, more often, a few weeks later. The reduction of the lacrymal flow induced corneal lesions in all 11 patients and 6 patients suffered permanent visual impairment. Biopsies of labial accessory salivary glands showed a lymphocytic infiltration of the glandular tissue in 5 of 7 cases. In 2 cases the lymphocytic infiltrate was nodular, grade III of Chisholm's classification, considered as pathognomonic of Sjogren's syndrome. The occurrence of Sjogren-like syndrome in patients recovering from TEN suggests an auto-immune pathogenesis for TEN, and is one more analogy between TEN and graft-versus-host disease.