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Published in: BMC Ophthalmology 1/2019

Open Access 01-12-2019 | Stevens-Johnson Syndrome | Research article

Lacrimal passage irrigation in children with Stevens-Johnson syndrome or toxic epidermal necrolysis: a five-year retrospective study

Authors: Qin Xiang, Xu Gao, Jing Fang, Lianhong Pi, Xinke Chen, Lin Chen, Qing Liu

Published in: BMC Ophthalmology | Issue 1/2019

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Abstract

Background

To identity the effect of lacrimal system irrigation in the acute stage in children with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN).

Methods

A retrospective review of 39 patients with SJS or TEN from 2012 to 2017 was analyzed. Patients were divided into two subgroups according to whether they received irrigation in the acute stage. The irrigation group included 21 inpatients and the control group included 18 inpatients. The χ2 test was used to compare clinical findings and data in both groups.

Results

The rate of lacrimal system obstructions in the chronic stage of SJS or TEN in the irrigation group was significantly lower than in the control group (p < 0.01). A significant difference was also found between the epiphora rates in patients with SJS or TEN in the chronic stage in the two groups (p = 0.047). One of 15 patients with mild dry eyes or without dry eyes in the irrigation group had epiphora, and it affected five of 12 in the control group. The difference between the two groups was significant (p = 0.03). Epiphora in the two patients in the control group was long-term, owing to the disappearance of puncta marks.

Conclusions

Lacrimal system irrigation with dexamethasone drops in the acute stage was a simple way to lessen lacrimal system obstructions and epiphora in patients with SJS or TEN. It should be considered a conventional ocular treatment for SJS or TEN.
Literature
1.
go back to reference Stevens AM, Johnson FC. A new eruptive fever associated with stomatitis and ophthalmia: report of two cases in children. Am J Dis Child. 1922;24:526–33.CrossRef Stevens AM, Johnson FC. A new eruptive fever associated with stomatitis and ophthalmia: report of two cases in children. Am J Dis Child. 1922;24:526–33.CrossRef
2.
go back to reference Lyell A. Toxic epidermal necrolysis: an eruption resembling scalding of the skin. Br J Dermatol. 1956;68(11):355–61.CrossRef Lyell A. Toxic epidermal necrolysis: an eruption resembling scalding of the skin. Br J Dermatol. 1956;68(11):355–61.CrossRef
3.
go back to reference Power WJ, Ghoraishi M, Merayo-Lloves J, Neves RA, Foster CS. Analysis of the acute ophthalmic manifestations of the erythema multiforme/Stevens-Johnson syndrome/toxic epidermal necrolysis disease spectrum. Ophthalmology. 1995;102(11):1669–76.CrossRef Power WJ, Ghoraishi M, Merayo-Lloves J, Neves RA, Foster CS. Analysis of the acute ophthalmic manifestations of the erythema multiforme/Stevens-Johnson syndrome/toxic epidermal necrolysis disease spectrum. Ophthalmology. 1995;102(11):1669–76.CrossRef
4.
go back to reference Rzany B, Mockenhaupt M, Baur S, Schroder W, Stocker U, Mueller J, Hollander N, Bruppacher R, Schopf E. Epidemiology of erythema exsudativum multiforme majus, Stevens-Johnson syndrome, and toxic epidermal necrolysis in Germany (1990-1992): structure and results of a population-based registry. J Clin Epidemiol. 1996;49(7):769–73.CrossRef Rzany B, Mockenhaupt M, Baur S, Schroder W, Stocker U, Mueller J, Hollander N, Bruppacher R, Schopf E. Epidemiology of erythema exsudativum multiforme majus, Stevens-Johnson syndrome, and toxic epidermal necrolysis in Germany (1990-1992): structure and results of a population-based registry. J Clin Epidemiol. 1996;49(7):769–73.CrossRef
5.
go back to reference Bachot N, Roujeau JC. Differential diagnosis of severe cutaneous drug eruptions. Am J Clin Dermatol. 2003;4(8):561–72.CrossRef Bachot N, Roujeau JC. Differential diagnosis of severe cutaneous drug eruptions. Am J Clin Dermatol. 2003;4(8):561–72.CrossRef
6.
go back to reference Yamane Y, Aihara M, Ikezawa Z. Analysis of Stevens-Johnson syndrome and toxic epidermal necrolysis in Japan from 2000 to 2006. Allergol Int. 2007;56(4):419–25.CrossRef Yamane Y, Aihara M, Ikezawa Z. Analysis of Stevens-Johnson syndrome and toxic epidermal necrolysis in Japan from 2000 to 2006. Allergol Int. 2007;56(4):419–25.CrossRef
7.
go back to reference Mockenhaupt M, Viboud C, Dunant A, Naldi L, Halevy S, Bouwes Bavinck JN, Sidoroff A, Schneck J, Roujeau JC, Flahault A. Stevens-Johnson syndrome and toxic epidermal necrolysis: assessment of medication risks with emphasis on recently marketed drugs. The EuroSCAR-study. J Invest Dermatol. 2008;128(1):35–44.CrossRef Mockenhaupt M, Viboud C, Dunant A, Naldi L, Halevy S, Bouwes Bavinck JN, Sidoroff A, Schneck J, Roujeau JC, Flahault A. Stevens-Johnson syndrome and toxic epidermal necrolysis: assessment of medication risks with emphasis on recently marketed drugs. The EuroSCAR-study. J Invest Dermatol. 2008;128(1):35–44.CrossRef
8.
go back to reference Auquier-Dunant A, Mockenhaupt M, Naldi L, Correia O, Schroder W, Roujeau JC. Correlations between clinical patterns and causes of erythema multiforme majus, Stevens-Johnson syndrome, and toxic epidermal necrolysis: results of an international prospective study. Arch Dermatol. 2002;138(8):1019–24.CrossRef Auquier-Dunant A, Mockenhaupt M, Naldi L, Correia O, Schroder W, Roujeau JC. Correlations between clinical patterns and causes of erythema multiforme majus, Stevens-Johnson syndrome, and toxic epidermal necrolysis: results of an international prospective study. Arch Dermatol. 2002;138(8):1019–24.CrossRef
9.
go back to reference French LE. Toxic epidermal necrolysis and Stevens Johnson syndrome: our current understanding. Allergol Int. 2006;55(1):9–16.CrossRef French LE. Toxic epidermal necrolysis and Stevens Johnson syndrome: our current understanding. Allergol Int. 2006;55(1):9–16.CrossRef
10.
go back to reference Ciralsky JB, Sippel KC, Gregory DG. Current ophthalmologic treatment strategies for acute and chronic Stevens-Johnson syndrome and toxic epidermal necrolysis. Curr Opin Ophthalmol. 2013;24(4):321–8.CrossRef Ciralsky JB, Sippel KC, Gregory DG. Current ophthalmologic treatment strategies for acute and chronic Stevens-Johnson syndrome and toxic epidermal necrolysis. Curr Opin Ophthalmol. 2013;24(4):321–8.CrossRef
11.
go back to reference Fu Y, Gregory DG, Sippel KC, Bouchard CS, Tseng SC. The ophthalmologist's role in the management of acute Stevens-Johnson syndrome and toxic epidermal necrolysis. Ocul Surf. 2010;8(4):193–203.CrossRef Fu Y, Gregory DG, Sippel KC, Bouchard CS, Tseng SC. The ophthalmologist's role in the management of acute Stevens-Johnson syndrome and toxic epidermal necrolysis. Ocul Surf. 2010;8(4):193–203.CrossRef
12.
go back to reference Fernandes M, Sridhar MS, Sangwan VS, Rao GN. Amniotic membrane transplantation for ocular surface reconstruction. Cornea. 2005;24(6):643–53.CrossRef Fernandes M, Sridhar MS, Sangwan VS, Rao GN. Amniotic membrane transplantation for ocular surface reconstruction. Cornea. 2005;24(6):643–53.CrossRef
13.
go back to reference Dua HS, Gomes JA, King AJ, Maharajan VS. The amniotic membrane in ophthalmology. Surv Ophthalmol. 2004;49(1):51–77.CrossRef Dua HS, Gomes JA, King AJ, Maharajan VS. The amniotic membrane in ophthalmology. Surv Ophthalmol. 2004;49(1):51–77.CrossRef
14.
go back to reference Auran JD, Hornblass A, Gross ND. Stevens-Johnson syndrome with associated nasolacrimal duct obstruction treated with dacryocystorhinostomy and Crawford silicone tube insertion. Ophthal Plast Reconstr Surg. 1990;6(1):60–3.CrossRef Auran JD, Hornblass A, Gross ND. Stevens-Johnson syndrome with associated nasolacrimal duct obstruction treated with dacryocystorhinostomy and Crawford silicone tube insertion. Ophthal Plast Reconstr Surg. 1990;6(1):60–3.CrossRef
15.
go back to reference Bron AJ, Foulks GN. Lemp MA. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). The ocular surface. 2007;5:(2);75–92. Bron AJ, Foulks GN. Lemp MA. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). The ocular surface. 2007;5:(2);75–92.
16.
go back to reference Shammas MC, Lai EC, Sarkar JS, Yang J, Starr CE, Sippel KC. Management of acute Stevens-Johnson syndrome and toxic epidermal necrolysis utilizing amniotic membrane and topical corticosteroids. Am J Ophthalmol. 2010;149(2):203–13 e202.CrossRef Shammas MC, Lai EC, Sarkar JS, Yang J, Starr CE, Sippel KC. Management of acute Stevens-Johnson syndrome and toxic epidermal necrolysis utilizing amniotic membrane and topical corticosteroids. Am J Ophthalmol. 2010;149(2):203–13 e202.CrossRef
Metadata
Title
Lacrimal passage irrigation in children with Stevens-Johnson syndrome or toxic epidermal necrolysis: a five-year retrospective study
Authors
Qin Xiang
Xu Gao
Jing Fang
Lianhong Pi
Xinke Chen
Lin Chen
Qing Liu
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Ophthalmology / Issue 1/2019
Electronic ISSN: 1471-2415
DOI
https://doi.org/10.1186/s12886-018-1014-9

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