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    2016 Resident Writer's Award Winner: 10 tips for TEN

    Treating OSD associated with toxic epidermal necrolysis

     

    Summary and conclusions

    Ten key points in the management of TEN:

    1. SJS/TEN is a severe life-threatening inflammatory reaction associated with common medications such as sulfa drugs, which should be discontinued.

    2. The overall risk of mortality with SJS/TEN is 20-25%.

    3. Up to 80% patients with SJS/TEN have ocular involvement.

    4. Urgent ophthalmologic assessment is necessary.

    5. Acute ocular involvement may be mild with only conjunctivitis, but can progress rapidly to include corneal and conjunctival defects.

    6. Early use of topical corticosteroids and antibiotics is recommended.

    7. Treatment with systemic corticosteroids and IVIG is controversial and has not been shown to improve ocular outcomes.

    8. Corneal and conjunctival epithelial sloughing should be treated with amniotic membrane grafts, including use of rings or sutured placement.

    9. Long-term complications include scarring, symblephara, dry eye, and trichiasis, which can lead to severe discomfort and ultimately blindness.

    10. Close follow-up and treatment of acute ocular involvement can prevent long-term visual loss.

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