Toxic epidermal necrolysis associated with meibomian gland dysfunction: Report of a case managed by thermal pulsation treatment

Purpose: To report a case of toxic epidermal necrolysis (TEN) with meibomian gland dysfunction demonstrating improvement in signs and symptoms after a single thermal pulsation system treatment (TPST). Methods: Baseline signs (meibomian gland assessment [MGA] scores and lipid layer thickness [LLT]) and symptoms (SPEED and OSDI scores) were evaluated in a 41 year old Caucasian female with a 16 years history of dry eye diseases secondary to a TEN episode. The patient was treated with a single 12-min TPST and re-evaluated at 3, 9, and 36 months post-treatment. Results: At 3 months post-TPST, both signs and symptoms scores improved relative to baseline and when re-measured at 9 months and 3 years. Conclusion: This report is the first to suggest the benefit of TPST on improving dry eye signs and symptoms in TEN. Interestingly, the improvement in symptoms as measured by SPEED and OSDI, was paralleled by the improvement in signs (MGA and LLT). Improvements in signs and symptoms were sustained over baseline including the relative decline at 3 years from the optimum improvements post-TPST.