Corneal graft after drug-induced toxic epidermal necrolysis (Lyell's disease)

Toxic epidermal necrolysis (TEN) is a clinical syndrome characterized by extensive epidermal loss similar to that found in scalding. Drug sensitization is generally considered to be the mechanism leading to this condition. Severe ocular manifestations are present in nearly all patients. We report a case of TEN with severe ocular involvement, on whom two penetrating keratoplasties were performed in the same eye. Although the prognosis of keratoplasty is reported to be poor when cicatricial changes are present, after the second graft, our patient's symptoms of pain decreased and her visual acuity from light perception improved to 20/40. The graft remains transparent under immunosuppressive therapy twenty-three months after surgery.