1. Title: Use of Topical Cyclosporine 0
Title: Use of Topical Cyclosporine 0.5% in the Treatment of Acute Ocular Manifestation of Toxic Epidermal Necrolysis
Authors: Visvaraja Subrayan (FRCOphth), Caroline Binson (MBBS)
University Malaya, Kuala Lumpur, Malaysia
The authors have no financial interest to disclose

2. Introduction:
Severe cutaneous adverse reactions (SCARs) is a spectrum of condition which consists of erythema multiforme (EM), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and drug induced eosinophilia and systemic syndrome (DRESS).
The purpose of this project is to report the use of topical cyclosporine 0.5% inthe management of ocular manifestations of acute toxic epidermal necrolysis.

3. First Case:
Case 1 was an 18-year old female who developed TEN with ocular involvement after ingesting oral Augmentin (amoxicillin/clavulanate potassium, GlaxoSmithKline,US). Ocular assessment showed severe inflammation with swollen eyelids and thick pseudomembranous conjunctivitis. Both corneas had diffuse punctate epithelial erosions and filamentary keratitis.

5. Second case:
Case 2 was a 28 year old man with retroperitoneal dermoplastic small cell tumour who developed TEN after ingesting allopurinol. He had bilateral diffusely injected conjunctiva with slightly swollen eyelids. There was blister on the bulbar conjunctiva of the left eye and both corneas had extensive superficial punctate keratitis.

7. Third case:
Case 3 was a 60 year old man who developed TEN after commencing thalidomide. He had swollen eyelids, bilaterally upper tarsal ulceration, injected conjunctiva and pseudomembrane.
The ocular conditions did not improve despite intravenous and topical steroids with lubricants in all 3 cases.

9. After treatment:
All cases showed marked improvement after 3 days of topical cyclosporine. Slit lamp examination 3 months post treatment showed complete re- epithelization of the corneas and conjunctivae with no sign of cicatricial changes.

10. Conclusion
Topical cyclosporine 0.5% maybe an effective new modality in the treatment of acute ocular complications of TEN. It can also be used as an alternative in steroid responders and may also prevent dry eye in the chronic phase of the disease but a larger case series would be necessary to confirm this.