Caroline J Catt1, Gavin M Hamilton2, Joel Fish3, Kamiar Mireskandari1, Asim Ali4. 1. Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Burn Unit, Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada. 2. Burn Unit, Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada. 3. Burn Unit, Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 4. Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Burn Unit, Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada. Electronic address: asim.ali@sickkids.ca.
Abstract
PURPOSE: To describe the acute and chronic ocular manifestations of Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN Overlap syndrome (Overlap syndrome) in children. DESIGN: Retrospective case series. METHODS: Medical records of children admitted to the Hospital for Sick Children between 2001 and 2011 with SJS, TEN, and Overlap syndrome were reviewed. Demographic information, all abnormal ophthalmic findings (and median time to first diagnosis), visual acuities, and ophthalmic treatments prescribed were collected for each eye for every patient. RESULTS: Thirty-six children were identified for inclusion in the study. Twenty-nine (81%) had acute ocular involvement, including all patients with TEN (n = 7). Conjunctivitis was the most common (78%) clinical sign. This, together with conjunctival membranes and subconjunctival hemorrhage, were the earliest signs, presenting by a median of 1 day. The percentage of patients and median time to occurrence of complications were as follows: for lid margin ulceration and corneal epithelial defects, 25%, 3 days; conjunctival ulceration, 39%, 3.5 days; symblepharon, 28%, 4 weeks; corneal opacification, 11%, 4 months; limbal stem cell failure, 8%, 7 months; and corneal vascularisation, 8%, 10 months after admission. Over 90% of children maintain a visual acuity of 20/40 or better in each eye at a mean follow-up of 1.4 years. CONCLUSIONS: Ocular involvement in SJS, TEN, and Overlap syndrome is common and the ocular manifestations may develop many months after the initial presentation, mandating the need for long-term follow-up of these children. Despite the high frequency of sight-threatening disease, most children maintain good vision in the long term.
PURPOSE: To describe the acute and chronic ocular manifestations of Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN Overlap syndrome (Overlap syndrome) in children. DESIGN: Retrospective case series. METHODS: Medical records of children admitted to the Hospital for Sick Children between 2001 and 2011 with SJS, TEN, and Overlap syndrome were reviewed. Demographic information, all abnormal ophthalmic findings (and median time to first diagnosis), visual acuities, and ophthalmic treatments prescribed were collected for each eye for every patient. RESULTS: Thirty-six children were identified for inclusion in the study. Twenty-nine (81%) had acute ocular involvement, including all patients with TEN (n = 7). Conjunctivitis was the most common (78%) clinical sign. This, together with conjunctival membranes and subconjunctival hemorrhage, were the earliest signs, presenting by a median of 1 day. The percentage of patients and median time to occurrence of complications were as follows: for lid margin ulceration and corneal epithelial defects, 25%, 3 days; conjunctival ulceration, 39%, 3.5 days; symblepharon, 28%, 4 weeks; corneal opacification, 11%, 4 months; limbal stem cell failure, 8%, 7 months; and corneal vascularisation, 8%, 10 months after admission. Over 90% of children maintain a visual acuity of 20/40 or better in each eye at a mean follow-up of 1.4 years. CONCLUSIONS:Ocular involvement in SJS, TEN, and Overlap syndrome is common and the ocular manifestations may develop many months after the initial presentation, mandating the need for long-term follow-up of these children. Despite the high frequency of sight-threatening disease, most children maintain good vision in the long term.
Authors: Katie D White; Riichiro Abe; Michael Ardern-Jones; Thomas Beachkofsky; Charles Bouchard; Bruce Carleton; James Chodosh; Ricardo Cibotti; Robert Davis; Joshua C Denny; Roni P Dodiuk-Gad; Elizabeth N Ergen; Jennifer L Goldman; James H Holmes; Shuen-Iu Hung; Mario E Lacouture; Rannakoe J Lehloenya; Simon Mallal; Teri A Manolio; Robert G Micheletti; Caroline M Mitchell; Maja Mockenhaupt; David A Ostrov; Rebecca Pavlos; Munir Pirmohamed; Elena Pope; Alec Redwood; Misha Rosenbach; Michael D Rosenblum; Jean-Claude Roujeau; Arturo P Saavedra; Hajirah N Saeed; Jeffery P Struewing; Hirohiko Sueki; Chonlaphat Sukasem; Cynthia Sung; Jason A Trubiano; Jessica Weintraub; Lisa M Wheatley; Kristina B Williams; Brandon Worley; Wen-Hung Chung; Neil H Shear; Elizabeth J Phillips Journal: J Allergy Clin Immunol Pract Date: 2018 Jan - Feb
Authors: Chia-Yi Lee; Hung-Chi Chen; Jing-Yang Huang; Chi-Chin Sun; Chao-Bin Yeh; Hung-Yu Lin; Shun-Fa Yang Journal: Int J Environ Res Public Health Date: 2019-08-10 Impact factor: 3.390