1. Toxic epidermal necrolysis is a life-threatening illness that involves sloughing of 30% or more of the total body surface area. In this spectrum of disease, the inflammation affects not only skin but also causes erosion of the mucous membranes of the eyes, mouth and genitalia. A severity of the illness rating called SCORTEN is considered the gold standard for predicting mortality for the illness. This score uses multiple laboratory tests and total body surface skin involvement to calculate risk of mortality, but the rating does not include mucosal involvement. Since mucosal involvement, specifically ocular involvement, frequently occurs, the purpose of this study is to determine if the severity of ocular involvement could also be used as a simple independent clinical marker for prognosis, complications, and short-term mortality of the disease. PURPOSE Total Patients61 Hospital mortality 34.5% Respiratory Failure56% Sepsis26% Ocular Involvement Eyelid sloughing66% Conjunctival41% Injection27 (43%) Chemosis20 (33%) Symblepharon12 (20%) Pseudomembranes6 (10%) Corneal 41% Punctate erosions17 (28%) Epithelial defect11(18%) Ulcer1(2%) RESULTS Of the 61 biopsy-proven TEN patients reviewed, 34.5% died during hospitalization. The most common systemic complications were respiratory failure (56%) and sepsis (26%). The most common ocular complication was eyelid skin sloughing (65.5%), while the cornea and conjunctival were equally involved in 41% of cases. As a control, the SCORTEN value was significant to predict hospital mortality (p<0.001). The presence of injection had a predictive value that was significantly associated with mortality (p<0.008). Symblepharon was also significantly associated with mortality, (p<0.005, in chi square). Chemosis was significantly associated with respiratory failure (p<0.046, in chi square), while symblepharon showed a trend toward respiratory failure (p<0.052, in chi square). Ocular involvement did not have a significant association with sepsis.. This is a retrospective chart review of 61 patients with biopsy- proven TEN who were treated in the burn unit at Loyola Medical Center between 1997-2005. Ocular findings within 24-72 hours of admission, systemic complications, and condition at discharge were recorded. SCORTEN value was calculated using patient’s age, heart rate, percent total body surface sloughing within 24 hours, history of malignancy, bicarbonate, glucose, and blood urea nitrogen values (mmol/L). SSPS for Windows, version 10.0 (SPSS Inc, Chicago, IL) was used to determine two-sided chi-square tests and a logistic regression analysis, which was used to determine statistical significance and predictive values of the variables. Extensive keratinization and symblepharon formation found in TEN patients Presence of injection and symblepharon are clinical markers for increased risk of mortality Chemosis and symblepharon are clinical markers for increased risk of respiratory failure The most common ocular involvement in TEN patients is eyelid skin sloughing Severity of Ocular Involvement as an Independent Clinical Marker for Prognosis, Complications, and Short-Term Mortality in Patients with Toxic Epidermal Necrolysis Emily Velotta MD, Boris Gilman BS, Charles Bouchard MD. Severity of Ocular Involvement as an Independent Clinical Marker for Prognosis, Complications, and Short-Term Mortality in Patients With Toxic Epidermal Necrolysis Emily Velotta M.D. 1, Boris Dilman B.S. 2, Charles Bouchard M.D.. 1, Richard Gamelli, M.D. 2 1 Department of Ophthalmology, 2 Department of General Surgery and Burn Unit, 3 Stritch School of Medicine, Loyola University Medical Center, Maywood, IL METHODS DISCUSSION CONCLUSIONS Acknowledgements: Research supported by the Richard A. Perritt Charitable Foundation and the Illinois Society for the Prevention of Blindness. REFERENCES 1. Roujeau JC, Stern R. Severe adverse cutaneous reactions to drugs. N Eng J Med 1994; 331:1272-1285. 2. Bastuji-Garin S, Fouchard N, Bertocchi M, Roujeau J, Revuz J, Wolkenstein P. SCORTEN: A Severity-of-Illness Score for Toxic Epidermal Necrolysis. J Invest Derm 2000; 115:149-153. 3.Shulz JT, Sheridan RL, Ryan CM, MacKool B, Tompkins RG. A 10 year experience with toxic epidermal necrolysis. J Burn Care Rehab 2000; 21: 199-204.