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  • MIRM: Ocular Course and Management Suggestions

    By Lynda Seminara
    Selected By: Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, November 2020

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    Mycoplasma pneumoniae–induced rash and mucositis (MIRM) is a mild respiratory infection among a disease spectrum that includes erythema mul­tiforme, Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis. Although the incidence of MIRM is growing, little is known about the ocu­lar and visual sequelae of this infection. To better understand how MIRM af­fects the eye and how ophthalmologists can best manage it, Gise et al. reviewed the medical records of patients with MIRM. Although they noted excellent visual outcomes, they stressed that careful monitoring and a low thresh­old for intervention are vital to avoid permanent ophthalmic damage.

    For this study, the authors gathered data for patients with primary MIRM treated at Boston Children’s Hospi­tal, including treatments and visual outcomes. Primary end points were best-corrected visual acuity, long-term ocular sequelae, and duration and type of ophthalmic intervention.

    Fifteen patients were included in the study (10 males; median age at diag­nosis, 10.9 years). Four patients had more than one episode of MIRM, and ophthalmic involvement occurred in 13 (87%). Treatment varied according to the clinical course. A topical steroid was prescribed for all 15 patients, and the 13 with eye involvement also received an antibiotic. The follow-up time for patients whose eyes were affected ranged from two weeks to 50 months.

    Despite the steroid treatment, con­junctival involvement worsened, and permanent sequelae were a concern for several patients. Ultimately, three bilateral amniotic membrane trans­plantations were performed, and one bilateral sutureless amniotic membrane device (Prokera) was placed. No patient experienced visual loss. One patient who received less aggressive treatment had mild symblephara near the lateral canthus in each eye. Two others, both of whom had amniotic membrane transplantation, exhibited scarring/thickening of the eyelid margins and blepharitis.

    To the authors’ knowledge, this is the largest study of the ocular course for patients with formally diagnosed MIRM. Although the findings suggest that morbidity is much lower in MIRM than in related syndromes, the authors cautioned that lid margin scarring and symblephara may increase the risk of cicatricial conjunctivitis and ocular sur­face damage. Moreover, symblephara in patients who do not undergo amniotic membrane grafting emphasizes the importance of attentive follow-up and aggressive treatment when warranted.

    The original article can be found here.