A case of toxic epidermal necrolysis (ten) with severe chronic ocular complications in a healthy 46-year-old woman.

Toxic epidermal necrolysis (TEN), also known as Lyell's syndrome, is a severe drug reaction characterized by extensive destruction of the epidermis and mucosal epithelia. The eyes are typically involved in TEN. The precise pathomechanisms involved remain unknown. We present a case of toxic epidermal necrolysis in a healthy 46-yr-old female patient who had inhaled glycophosphate (herbicide) and was treated with paracetamol, aspirin, and chlorpheniramine. Thirty-five per cent of the skin area was affected by the syndrome, with involvement of conjunctival, gastrointestinal, and respiratory mucous membranes. Topical treatment was performed every day and the patient did not undergo surgery. Complete wound healing was achieved in 47 days. There were acute complications, consisting of infection of the skin areas ( Candida), gastrointestinal bleeding, pleural effusion, and severe ocular mucous membrane damage. The most serious chronic complication was the presence of significant opacity of the corneal epithelium, causing almost complete loss of vision. According to the data in the literature, ocular complications in TEN are frequent and are present in the majority of the patients studied, but are not often severe. Risk factors for the development of ocular complications are not known. Ocular sequelae may appear after the acute period and they can be extremely disabling, even causing almost complete loss of vision. Treatment includes corticosteroids and topical antibiotic therapy in the acute phase and if necessary corneal transplantation in the event of chronic damage to the corneal epithelium.