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A 26-year-old man with ocular complications after adverse reaction to phenytoin
Digital Journal of Ophthalmology 2016
Volume 22, Number 4
October 4, 2016
DOI: 10.5693/djo.03.2015.05.002
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Ritesh Gupta, MD | Faculty of Medicine, University of Toronto, Toronto, Canada
Vasudha Gupta, MD, FRCSC | Department of Ophthalmology, McMaster University, Hamilton, Ontario, Canada
Yasser Khan, MD, FRCSC | Faculty of Medicine, University of Toronto, Toronto, Canada Department of Ophthalmology, McMaster University, Hamilton, Ontario, Canada
Differential Diagnosis
Ocular cicatricial pemphigoid often presents with an insidious onset of redness, dryness, and foreign body sensation. It usually occurs in patients older than 55 years of age and is characterized by remission and exacerbations. Presentation often includes symblephara (inferior greater than superior) and foreshortening of the inferior fornix.

Staphylococcal scalded skin syndrome is caused by an exfoliative toxin produced by roughly 5% of Staphylococcus aureus. These toxins can lead to a red rash and separation of the epidermis with diffuse sheetlike desquamation.

Toxic shock syndrome is a potentially fatal illness caused by enterotoxin type B produced by Staphylococcus aureus. Patients demonstrate presence of an infection and systemic symptoms.

Phototoxic skin reaction refers to the development of cutaneous disease as a result of the combined effects of a chemical and light. Typically, they appear as an exaggerated sunburn response, but only on sun-exposed areas of the body.

Numerous other conditions may present in a similar fashion, including trachoma, cicatricial conjunctivitis secondary to chronic topical medications (especially pilocarpine, phospholine iodide and antiviral agents), chemical burn, and radiation treatment. In addition to the entities mentioned above, the possibility of a malignant process (eg, conjunctival intraepithelial neoplasia and squamous cell carcinoma) should always be considered, particularly in older patients with risk factors.
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