Cyanotic with blisters after 3 eye-drop doses: a rare Lyell syndrome case and its drug-safety lessons
Three eye-drop doses in 45 minutes left a man cyanotic, blistered across his body
On 14 August, the Ho Chi Minh City Hospital of Dermato-Venereology announced it had successfully treated a patient with toxic epidermal necrolysis (Lyell syndrome) — a rare but potentially life-threatening drug reaction — after just three doses of eye drops bought at a nearby pharmacy.
The patient, P.T.L. (51, from An Giang province), had itchy, painful eyes and purchased eye drops on his own. Within 45 minutes he used them three times. About five minutes after the third dose, the inside of his mouth began to blister and bleed. By evening his tongue had turned “peeled white” and painful, his body was cyanotic and stiff, almost numb, so his family rushed him to the emergency department.
After district and provincial facilities, the patient was transferred to the HCMC Hospital of Dermato-Venereology with severe oral mucosal erosions, crusted lips, widespread skin blisters, conjunctival lesions in both eyes and genital mucosal damage.
Diagnosis and a nearly three-week treatment journey
Dr. Nguyen Thi Minh Anh, Deputy Head of Clinical Department 3, said the presentation was typical of Lyell syndrome. Notably, despite systemic corticosteroids and topical skin care, the disease kept progressing: lesions spread, new blisters appeared, and the patient became exhausted and coughed up blood — a high-risk phase carrying dangers of infection, dehydration, electrolyte imbalance and multi-organ failure.
The team added the immunosuppressant ciclosporin combined with antibiotics to control the inflammatory response. After about a week, lesions began to improve; after nearly three weeks of intensive treatment, the patient was stable, eating and living normally again.
A view from pharmaceutical machinery and equipment makers
In essence, this was an idiosyncratic drug reaction tied to the patient’s constitution, not a manufacturer’s quality failure. Yet the case is a reminder for anyone in pharma: eye drops are sterile products, and their manufacturing standards are among the strictest in the industry.
Pharmacopoeias require eye drops to be sterile, free of undissolved particles, with pH and osmolality suited to the eye and well-studied preservatives. Modern plants commonly adopt Blow-Fill-Seal (BFS) technology — bottle forming, filling and sealing in one closed cycle to minimise contamination risk — combined with in-line inspection: particle inspection in bottles, fill-volume checks, cap and seal testing. Every released batch must keep complete records for traceability.
Aftermarket, pharmacovigilance systems with adverse drug reaction (ADR) reporting help regulators spot safety signals early, update labelling or issue recalls when needed — a safeguard for users that every pharmaceutical company must operate seriously.
Advice for eye-drop users
Dr. Minh Anh noted that eye drops are generally safe when used as indicated, but part of the medicine can still be absorbed through the conjunctiva into systemic circulation. People with a history of drug allergy, bronchial asthma, allergic rhinitis or atopic dermatitis should proactively inform healthcare staff so suitable medicines are chosen. If rash, fever, blisters, mucosal erosions, swollen lips or tongue, or breathing difficulty appear after using any medicine, stop it immediately and seek medical care promptly.
Source: Báo Dân trí (Dan Tri News) — https://dantri.com.vn/suc-khoe/nguoi-dan-ong-tim-tai-rop-loet-khap-nguoi-sau-3-lan-dung-thuoc-nho-mat-20260814120914079.htm