Plasmapheresis, intravenous immunoglobulins, and autologous serum eyedrops in the acute eye complications of toxic epidermal necrolysis

Eur J Ophthalmol 2017; 27(6): 658 - 663




Pinna, Antonio Nuvoli, Eleonora Blasetti, Francesco Posadinu, Maria Alma Boscia, Francesco



Toxic epidermal necrolysis (TEN) is a rare, life-threatening, drug-induced, mucocutaneous disease, which can severely affect the ocular surface. The purpose of this study was to investigate the efficacy of plasmapheresis, human IV immunoglobulins (IVIg), and autologous serum (AS) eyedrops in the treatment of the severe acute ocular complications of TEN.


A retrospective chart review of all patients admitted to the Burn Unit, Azienda Ospedaliero-Universitaria-Sassari, Sassari, Italy, from 2009 to 2015, identified 9 patients (2 men, 7 women; mean age 63.8 ± 24.7 years) with TEN. Bilateral, acute ocular surface complications were observed in 7 (78%) patients; 3 showed catarrhal conjunctivitis, whereas 4 had severe pseudomembranous conjunctivitis and corneal ulcers.


All patients with TEN were immediately treated with plasmapheresis and human IVIg, which produced a marked improvement in the patients’ general condition. In the 3 with catarrhal conjunctivitis, preservative-free artificial tears and topical antibiotics were beneficial. In the 4 with severe pseudomembranous conjunctivitis and corneal ulcers, treatment with AS eyedrops resulted in corneal and conjunctival epithelium healing over 3-6 weeks. After a minimum follow-up of at least 12 months, there were minimal/mild residual signs and symptoms of dry eye.


Plasmapheresis and IVIg may be life-saving and contribute to reduce ocular surface inflammation in TEN. Autologous serum eyedrops, prepared after plasmapheresis completion and IVIg infusion, may be helpful in the management of the severe acute ocular complications of TEN.

Article History


Financial support: No financial support was received for this submission.
Conflict of interest: None of the authors has conflict of interest with this submission.
Meeting presentation: Presented in part as a scientific poster at the 17th annual meeting of the European Association for Vision and Eye Research, Nice, France, October 1-4, 2014, and at the 21st annual scientific meeting of the Medical Contact Lens & Ocular Association, London, UK, November 28, 2014.

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