I do not know how to treat a patient who has Lyell syndrome and ocular problem of lids synechie, synechie lids and ocular globe. We do not have amniotic membrane. The patient is 65 years old; the onset is one month and is acute.

Without amniotic membranes; the standard of care for acute toxic epidermal necrolysis (TEN) or Steven Johnson syndrome would be the placement of symblepharon rings and daily sweeping of the superior and inferior conjunctival fornices with glass rods.  Clean scleral depressor can be used as well.  The use of topical steroids is controversial, but prophylaxis against infection by the use of antibiotic ointment on the surface of the eye 4 times a day is mandatory.  Tobramycin is probably a good choice for the ointment.  Daily follow-up is mandatory.  During the acute phase, prevention of symblepharon formation and infection is the goal.  Amniotic membrane, of course, can be applied within the first week to the surface of the eye in a technique described by my colleague, Darren Gregory in a recent publication in Ophthalmology.  One month out is too late. Michael Taravella, M.D.

References:

1.  Roy FH. Fuchs-Lyell Syndrome. In:  Ocular Syndromes and Systemic Diseases, 4th edition.

2.  Moussala M, Binam F, Nkam M, Kouda Zeh A, Bengono G.  Ocular Manifestations and sequelae of Lyell syndrome caused by sulfadoxine-pyrimethamine in Cameroon.  J Fr Ophthal, 1998, Jan. Vol. 21 (1): 72-77.