Beyond The Skin: Ocular Sequelae Of Toxic Epidermal Necrolysis (Lyell Syndrome): Clinical Outcomes And Management Challenges

The purpose of our study is to describe the spectrum of long-term complications of Toxic Epidermal Necrolysis, to evaluate the efficacy of multidisciplinary management in preserving visual function during the chronic phase, and to assess the repercussions of the disease on the personal and professional life of the patient. 

Ophthalmology Department within the Military Training Hospital in Rabat Morocco

A prospective observation on a case diagnosed with Toxic Epidermal Necrolysis. Clinical assessment included Best corrected visual acuity, Ocular Surface Disease Index (OSDI) scoring, and detailed slit-lamp examination focused on Schirmer's testing, lid malposition, symblepharon formation, and corneal limbal stem cell deficiency (LSCD). Socio-professional impact was also evaluated through semi-structured interviews focusing on employment status, driving ability, and social reintegration.

Patient aged 52 presented with bilateral cicatricial ocular surface disease 12 months after the acute phase of Toxic Epidermal Necrolysis. Clinical findings included limbal stem cell deficiency, Stage II Symblepharon, and cicatricial entropion. Mean OSDI score was > 75, indicating severe disability. The socio-professional and psychological consequences were significant. The chronic ocular pain and irreversible visual impairment, coupled with the traumatic memory of the acute systemic crisis, led to clinical depression characterized by social withdrawal and a profound sense of isolation. Professionally, due to chronic photophobia, visual instability, and psychological distress, the patient was declared unfit, resulting in medical discharge. 

The morbidity of Lyell Syndrome extends far beyond the acute dermatological crisis. The visual morbidity leads to profound socio-professional exclusion that persists long after skin healing. Our observation demonstrates that even with access to specialized care, the ''visual handicap" remains a barrier to professional reintegration. Early aggressive ocular surface management and long-term vocational support are essential to minimize the life-altering impact of this condition.