MANAGEMENT OF A DIFFICULT CASE OF TOXIC EPIDERMAL NECROLYSIS AFTER TOPICAL USE OF CHLORAMPHENICOL

To present the management of an interesting case of Toxic Epidermal Necrolysis (TEN), which was induced after topical chloramphenicol use.

Ocular Surface Service, Ophthalmology Dpt., Konstantopouleio-Patission Gen. Hptl., Athens, Greece, 2012-2024

A 32 year-old woman came to our clinic due to discomfort and dry eye symptoms, reporting an episode of TEN after topical chloramphenicol use, 9 months ago. Slit-lamp examination revealed extensive lid and ocular surface inflammation mainly in the right eye(RE). The patient was treated with topical therapy. There was no follow-up for 5 years, in which period, she underwent an unknown lower right lid intervention elsewhere, due to distichiasis. Due to repeated corneal ulcers and continuous pain from her right eye, she returned to our clinic. Eyelid fibrosis, distichiasis, corneal abrasions and a paracentral small ulcer in her right eye were present. Buccal mucosa transplantation on both lid margins of RE was performed. Additionally, an amniotic membrane was transplanted in the upper tarsal lid area, after removal of the defective tissue.

Transplantation of buccal mucosa in combination with amniotic membrane along with local treatment, managed to control the majority of the patient’s symptoms. Due to the natural evolving of the disease, she now wears daily contact lenses and is symptom-free for long time periods, 12 years since her initial diagnosis.

Tο our knowledge this is the first case of TEN induced after chloramphenicol drops  use. A TEN with heavy ocular involvement challenges ophthalmologists and patients due to the long-term sequalae of the disease.