trimethoprim--sulfamethoxazole-drug-combination and Keratoconjunctivitis

To report a new surgical technique to manage severe acute toxic epidermal necrolysis.. Two interventional case reports.. Two patients. Case 1: A 6-year-old boy had severe toxic epidermal necrolysis develop after being treated with trimethoprim and sulfamethoxazole for chronic otitis media. Both eyes and eyelids were affected. He underwent bilateral lysis of symblepharon and all adhesions and bilateral amniotic membrane transplantation to the entire ocular surface except the cornea. Loss of eyelid skin required transplantation of amniotic membrane to all four eyelids and strips of amniotic membrane at the eyelid margins. Case 2: An 8-year-old girl with severe toxic epidermal necrolysis associated with mycoplasma pneumonia had bilateral, diffuse keratoconjunctivitis, diffuse corneal epithelial defects, and bilateral symblepharon. Amniotic membrane transplantation was performed bilaterally, using a symblepharon ring in the left eye.. Amniotic membrane transplantation.. Preservation of normal ocular and eyelid surfaces and prevention of blindness.. Case 1: Thirty-six months after bilateral ocular surgery, there is no symblepharon, good ocular surface wetting, and an uncorrected bilateral vision of 20/20. Case 2: Amniotic membrane transplantation protected both ocular surfaces and prevented conjunctival contracture without adhesion of the eyelids to the ocular surface. The central vision was preserved. There was minimal peripheral corneal vascularization and mild conjunctival scarring of the tarsal conjunctival surface 34 months postoperatively.. These are the first cases of acute toxic epidermal necrolysis treated with amniotic membrane transplantation and the first use of the procedure on external eyelid surfaces with good healing of the eyelids. This new treatment for acute toxic epidermal necrolysis preserves normal ocular and eyelid surfaces and may prevent blindness.

Topics: Acute Disease; Amnion; Child; Eyelid Diseases; Female; Humans; Keratoconjunctivitis; Male; Ophthalmologic Surgical Procedures; Pneumonia, Mycoplasma; Stevens-Johnson Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity

Recent reports suggest that acquired immunodeficiency syndrome (AIDS) patients are at higher risk of developing mucocutaneous reactions such as toxic epidermal necrolysis and Stevens-Johnson syndrome (SJS). Resultant dry eye may be further exacerbated by human immunodeficiency virus (HIV) related lacrimal gland dysfunction and lead to a chronic keratoconjunctivitis. We report one patient with AIDS and toxic epidermal necrolysis and two patients with AIDS and SJS who developed severe dry eye misdiagnosed as infectious keratoconjunctivitis. Cicatrizing mucocutaneous reactions should be suspected in AIDS patients and the dry eye treated to control symptoms and prevent complications.

Topics: Acquired Immunodeficiency Syndrome; Adult; Dry Eye Syndromes; Humans; Keratoconjunctivitis; Lacrimal Apparatus Diseases; Male; Stevens-Johnson Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

Long-term sulfonamide therapy for a urinary tract disorder was believed to have caused toxicosis of the lacrimal gland, and subsequently, dry eyes. Initial topical treatment of the ulcers may have potentiated the dry eye condition. The dog was referred with negligible tear production and bilateral corneal ulcers. Diagnostic evaluation of the urinary tract indicated reflex dyssynergia, a neurologic disorder causing functional urinary tract obstruction. The combination of appropriate topical and surgical therapy of the eyes, discontinuation of sulfonamide treatment, and initiation of bethanechol in the treatment of reflex dyssynergia all contributed to return of a normal tear film. Any combination of systemic and/or topical therapy may affect lacrimal secretion. The clinician must be cognizant of the potential effects that systemic medication, particularly antimicrobial drugs and drugs affecting the autonomic nervous system, may have on lacrimal secretions.

Topics: Animals; Corneal Ulcer; Dog Diseases; Dogs; Drug Combinations; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Male; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urination Disorders