Nasolacrimal duct obstruction after toxic epidermal necrolysis

Toxic epidermal necrolysis also known as Lyell's syndrome is acute dermatomyositis as an adverse drug reactions. It is characterized by erosions of skin over 30% of total body surface area and is associated with significant mortality of 25%-50% of cases. The conjunctival mucosa involvement could result in cornea erosion and ulceration. Other ocular complications are: purulent conjunctivitis with pseudomembrane formation, entropion, symblefaron and synechiae with nasolacrimal duct obstruction or punctual stenosis. The authors present a very rare complication of nasolacrimal duct obstruction after toxic epidermal necrolysis in young girl. The endoscopic dacricystorhinostomy with one lacrimal point intubation was performed. Early ophthalmic assessment and frequent follow-up could be helpful to avoid metaplasia of epithelium, vascular neoplasia in conjunctiva and cornea. This will protect from dysfunction of tears secretion causing nasolacrimal duct or lacrimal point obliteration. If there is a permanent epiphora the endoscopic dacriocystorhinostomy, with silicone tube intubation could be the method of choice. A satisfactory results are also obtained after opening a passage of only one occluded lacrimal point.