3-Year Re-Audit Of 10-Year Retrospective Review Of Ocular Involvement In Toxic Epidermal Necrolysis At A Tertiary Hospital
Published 2026 - 44th Congress of the ESCRS
Reference: PP23.10 | Type: Free paper | DOI: 10.82333/s7c9-3v10
Authors: Dr Alexa Korb* 1 , Mr Oz Levinkron 2 , Aditi Pandey 3 , Dr Clare Bailey 4 , Mr Declan Collins 4 , Mr Jorge Leon-Villapalos 4 , Mr Richard Scawn 5 , Ms Manvi Sobti 4 , Ms Olivia Li 5
1Imperial College Healthcare Trust,London,United Kingdom, 2Moorfields Eye Hospital,London,United Kingdom, 3Royal Melbourne Hospital,Melbourne,Australia, 4Chelsea and Westminster Hospital,London,United Kingdom, 5Chelsea and Westminster Hospital,London,United Kingdom;The Royal Marsden Hospital,London,United Kingdom
Purpose
Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are potentially life-threatening diseases of skin and mucosae. Acute ocular involvement is common, presenting in over 50% of TEN cases. Medical management may include lubricating, topical steroid, immunomodulatory and antibiotic eye drops. Amniotic membrane graft (AMG) transplantation may be recommended in severe cases. In spite of its high burden of morbidity and mortality, the evidence base for management of SJS and TEN is currently limited by disease rarity, occurring in 1 to 2 cases per million people. We present the ocular outcomes of ten cases of SJS occurring at a tertiary hospital between 2023-2026 as a re-audit of practice following a 10-year case review.
Setting
Ophthalmology department, Chelsea and Westminster Hospital, London, United Kingdom.
Methods
A retrospective case review was conducted of all patients (10 cases) referred with SJS to the ophthalmology service at Chelsea and Westminster Hospital (CWH), a tertiary centre with multidisciplinary expertise including a burns unit, between 2023-2026. 8 cases had progressed to TEN. This was compared to the outcomes of 24 cases audited between 2013-2023. Data collected included ocular involvement, severity (Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN)), ophthalmology input frequency, medical/surgical management, days to amniotic membrane transplantation and ocular outcomes at follow-up after discharge. Data was compared with the CWH TEN management protocol as a standard.
Results
Of 10 cases in the current audit, all but one (90%) had ocular involvement. Of those applicable (9 cases), ocular disease severity varied (moderate-to-severe (1 case), severe (6 cases), extremely severe (2 cases)). A moderate positive correlation (Correlation Coefficient=0.46) was observed between ocular severity and SCORTEN score. 7 patients underwent AMG transplantation; minimal ocular complications were noted at final outpatient follow-up. 2 patients passed away during their inpatient stay.
In the previous sample, 2/3 had worsening vision post-TEN. At final follow-up of the current sample, all surviving patients achieved a mean visual acuity (VA) across all eyes of logMAR -0.01 (±0.08); mean VA in the TEN group was -0.02 (±0.10).
Conclusions
Early and frequent ophthalmic input in SJS/TEN is paramount to optimise management of these rare but life-threatening conditions. The outstanding visual security achieved at final follow-up can be attributed to several changes in practice: earlier amniotic membrane grafting- often before epithelial defect onset, the addition of corneal expertise, earlier infection identification and reduced topical corticosteroid intensity. Management also benefitted from a single-centre multidisciplinary team presence. Mortality was greater in the current audit (20% in currently : 4% previously) although sample size reduced (10 cases vs. 24 cases). Ongoing service evaluation and adherence to a strict protocol aligns with future improvement of outcomes.