Management of ocular involvement in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis: french national audit of practices, literature review, and consensus agreement.

Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) can lead to severe ophthalmologic sequelae. The main risk factor is the severity of the initial ocular involvement. There are no recommendations for ocular management during acute phase.We conducted a national audit of current practice in the 11 sites of the French reference center for toxic bullous dermatoses and a review of the literature to establish therapeutic consensus guidelines. We sent a questionnaire on ocular management practices in SJS/ TEN during acute phase to ophthalmologists and dermatologists. The survey focused on ophthalmologist opinion, pseudomembrane removal, topical ocular treatment (i.e. corticosteroids, antibiotics, antiseptics, artificial tear eye drops, vitamin A ointment application), amniotic membrane transplantation, symblepharon ring use, and systemic corticosteroid therapy for ophthalmologic indication. Nine of 11 centers responded. All requested prompt ophthalmologist consultation. The majority performed pseudomembrane removal, used artificial tears, and vitamin A ointment (8/9, 90%). Combined antibiotic-corticosteroid or corticosteroid eye drops were used in 6 centers (67%), antibiotics alone and antiseptics in 3 centers (33%). Symblepharon ring was used in 5 centers (55%) if necessary. Amniotic membrane transplantation was never performed systematically and only according to the clinical course. Systemic corticosteroid therapy was occasionally used (3/9, 33%) and discussed on a case-by-case basis.The literature about ocular management practice in SJS/ TEN during acute phase is relatively poor. The role of specific treatments such as local or systemic corticosteroid therapy is not consensual. The use of preservatives, often present in eye drops and deleterious to the ocular surface, is to be restricted. Early amniotic membrane transplantation seems to be promising.

Steroid treatment in ocular tuberculosis: A double-edged sword?

INTRODUCTION: We report the case of a Caribbean patient with an atypical presentation of bilateral tuberculous chorioretinopathy. PATIENT AND METHODS: A 57-year-old woman, with hypertension and non-insulin dependent diabetes, was referred to our center for a sudden loss of vision in the right eye to hand motions. Ophthalmic examination revealed only right papilledema. Brain magnetic resonance imaging was normal. Laboratory examination revealed no signs of inflammation. A right non-arteritic acute anterior ischemic optic neuropathy was first suspected. One week later, the visual acuity (VA) in the left eye dropped from 10/10 to 5/10 with the appearance of papilledema on fundoscopic exam. This bilaterality led us to begin intravenous corticosteroids followed by transition to oral. This improved the left eye VA to 10/10. Numerous bilateral white patches in the posterior pole appeared secondarily, hypofluorescent in the intermediate and late phases of angiography. RESULTS: The research of the etiology of uveitis showed a positive tuberculin skin test without any prior vaccination. The vitreous humor sample was negative on direct examination, by culture and by polymerase chain reaction (PCR). DISCUSSION: Systemic corticosteroid therapy for ocular tuberculosis is not well described. It may theoretically treat the inflammatory portion of the lesions due to type IV hypersensitivity reaction as in meningeal and pericardial involvement. CONCLUSION: The clinical spectrum of ocular tuberculosis is wide and the diagnosis should be considered in any intraocular inflammatory condition of a chronic or acute recurrent nature, whether or not responsive to steroids.

[Infectious keratitis and cosmetic lenses: a five-case retrospective study]. / Kératites infectieuses et lentilles cosmétiques : étude rétrospective de cinq cas.

PURPOSE: To determine the characteristics of infectious keratitis related to plano cosmetic lenses. METHODS: Retrospective case study of a series of infectious keratitis among plano cosmetic lenses wearers. The main parameters were demographic data, medical history, risk factors for infectious complications and keratitis severity criteria, microbiological results, clinical course, and final visual acuity. RESULTS: Five patients were included, all females, ranging from 15 to 50 years of age. Four were emmetropic. One patient had undergone refractive photokeratectomy a few months before. All had risk factors for infectious complications. The fundamental causes of infections were diverse: bacterial abscesses, keratomycosis, and amoebic keratitis. All presented severity criteria. In two cases, the keratitis led to severe consequences with legal blindness requiring penetrating keratoplasty in one case. DISCUSSION: Infectious keratitis in plano cosmetic lenses wearers is not rare and may have dramatic consequences. Sales are specifically regulated and the lenses are considered cosmetic products, not medical devices. The sales regulations for plano cosmetic lenses should be updated, as several countries have already done after encountering many serious incidents.