中毒性表皮坏死松解症导致眼部远期并发症1例

中毒性表皮坏死松解症与Stevens-Johnson综合征是一种由药物反应引起的严重的表皮及黏膜的不良反应。最常发生于成人,与服用磺胺类、巴比妥类、非类固醇抗炎药、苯妥英纳、醋甲唑胺、别嘌呤醇和青霉素等药物有关。约有1/5的患者否认有服药史,约在1/3病例中由于同时患有严重疾病及用药物治疗而病因不明。中毒性表皮坏死松解症为皮肤科少数病情危重的疾病之一,其死亡率达30%~35%。20%~40%的存活者有眼睛受累。少数患者由于泪管阻塞可出现泪眼,多数患者表现为睫毛、眼睑上皮增生,伴鳞状化生、结膜和角膜新生血管形成,引起一种中毒性表皮坏死松解症眼综合征。经及时治疗中毒性表皮坏死松解症可好转。但是部分患者眼部情况可继续发展,可引起畏光、灼痛、视力下降甚至失明。现汇报1例中毒性表皮坏死松解症眼综合征患者眼部远期并发症。

A case of long-term ocular complications caused by toxic epidermal necrolysis

Toxic epidermal necrolysis is a serious adverse drug reaction of the epidermis and mucosae that most commonly occurs in adults and is associated with the use of sulfonamides, barbiturates, non-steroid anti-inflammatory drugs, phenytoin, methazolamide, allopurinol, and penicillin. Approximately one out of five patients denied a history of medication, and in approximately one out of three cases, the causes were unknown due to both serious illness and drug treatment. Toxic epidermal necrolysis is one of the few critical diseases in dermatology, with an associated mortality rate of 30%-35%; 20%-40% of the survivors have ocular complications. A few patients can have teary eyes due to tear duct obstruction, but most patients have hyperplasia with eyelashes and blephral epithelium, with squamous biochemical, conjunctival, and corneal new angiogenesis, causing a toxic epidermal necrosis and pyrolysis eye syndrome. Toxic epidermal necrolysis could be managed with timely treatment; however, in some patients, the condition could persist, leading to photophobia, burning pain, vision loss, and even blindness. Here, we report a case of long-term ocular complications of toxic epidermal necrolysis in Tibet.