Purpose.: Ocular complications related to Stevens-Johnson Syndrome (SJS)–Toxic Epidermal Necrolysis (TEN) may persist and progress after resolution of systemic disease. This is thought to be related in part to persistent ocular innate-immune signaling. In this study, our aim was to characterize infiltrative conjunctival cellular profiles during acute (< 12 months) and chronic (> 12 months) disease.

Methods.: Consecutive patients presenting with SJS-TEN over a 12-month period were followed for 1 year. Detailed clinical examination and conjunctival impression cell recovery was analyzed by flow cytometry for the presence of intraepithelial leukocytes and compared with healthy controls (n= 21).

Results.: Ten patients were recruited of whom six had acute disease and five were classified as TEN (SCORTEN= 1, n= 4). Conjunctival inflammation was graded as absent/mild in a total of nine patients; but despite this, evidence of fornix shrinkage was observed in nine subjects. This inversely correlated with disease duration (P< 0.05). A reduction in percentage of CD8αβ+ T cells compared with controls (80% vs. 57%; P< 0.01) was associated with a corresponding increase in the number/percentage of CD45 INT CD11b+ CD16+ CD14− neutrophils (186 vs. 3.4, P< 0.01, 31% vs. 0.8%, P< 0.001). Neutrophils inversely correlated with disease duration (r=− 0.71, P= 0.03), yet there was no absolute change in the CD8αβ+ or neutrophil populations during the study period (P= 1.0).

Conclusions.: These data highlight that a neutrophilic infiltrate is present in mildly inflamed or clinically quiescent conjunctival mucosa in patients with ocular SJS-TEN, where neutrophil numbers inversely correlate with disease duration. Neutrophil persistence endorses the hypothesis of an unresolved innate-inflammatory process that might account for disease progression.