Transcript Title: Use of Topical Cyclosporine 0.5% in the Treatment

Title: Use of Topical
Cyclosporine 0.5% in the
Treatment of Acute Ocular
Manifestation of Toxic
Epidermal Necrolysis
Authors: Visvaraja Subrayan (FRCOphth), Caroline Binson (MBBS)
University Malaya, Kuala Lumpur, Malaysia
Email: [email protected]
The authors have no financial interest to disclose
Introduction:
Severe cutaneous adverse reactions (SCARs) is a
spectrum of condition which consists of erythema
multiforme (EM), Stevens-Johnson syndrome
(SJS), toxic epidermal necrolysis (TEN) and drug
induced eosinophilia and systemic syndrome
(DRESS).
 The purpose of this project is to report the use of
topical cyclosporine 0.5% inthe management of
ocular manifestations of acute toxic epidermal
necrolysis.

First Case:
 Case
1 was an 18-year old female who
developed TEN with ocular involvement after
ingesting
oral
Augmentin
(amoxicillin/clavulanate
potassium,
GlaxoSmithKline,US).
Ocular
assessment
showed severe inflammation with swollen
eyelids
and
thick
pseudomembranous
conjunctivitis. Both corneas had diffuse
punctate epithelial erosions and filamentary
keratitis.
Second case:
 Case
2 was a 28 year old man with
retroperitoneal dermoplastic small cell
tumour who developed TEN after ingesting
allopurinol. He had bilateral diffusely
injected conjunctiva with slightly swollen
eyelids. There was blister on the bulbar
conjunctiva of the left eye and both
corneas had extensive superficial punctate
keratitis.
Third case:
 Case
3 was a 60 year old man who
developed
TEN
after
commencing
thalidomide. He had swollen eyelids,
bilaterally
upper
tarsal
ulceration,
injected
conjunctiva
and
pseudomembrane.
 The ocular conditions did not improve
despite intravenous and topical steroids
with lubricants in all 3 cases.
After treatment:
 All
cases showed marked improvement
after 3 days of topical cyclosporine.
Slit lamp examination 3 months post
treatment showed complete reepithelization of the corneas and
conjunctivae with no sign of cicatricial
changes.
Conclusion
 Topical
cyclosporine 0.5% maybe an
effective new modality in the treatment
of acute ocular complications of TEN. It
can also be used as an alternative in
steroid responders and may also prevent
dry eye in the chronic phase of the
disease but a larger case series would be
necessary to confirm this.