Principles of eye management in Stevens- Johnson syndrome

Abstract

Stevens-Johnson syndrome and toxic epidermal necrosis though rare, are important group of diseases where an ophthalmologist plays an important role in minimizing serious eye sequel and preserving vision. Medications are common cause of this group of diseases. Infections and malignancy can also cause the same. Eye involvement in the form of conjunctivitis and denudation of eyelid margin skin are the earliest manifestations. Involving an eye surgeon whenever the diagnosis is suspected will help in early diagnosis and management. Covering the entire ocular surface and lid margin with amniotic membrane along with topical and systemic Immunosuppressive therapy are the first line-up of treatment in a diagnosed case with eye manifestations. These patients need to be followed up regularly for membrane formation, early symblepharon formation and corneal ulcers. Keratinized eyelid margin and inner eyelid surface can lead to chronic inflammation and neovascularisation of cornea. Aqueous, mucin and lipid tear deficiency can all occur. Mucous membrane grafts, scleral contact lens and autologous cultivated oral mucosal epithelial transplantations are procedures performed to stabilize the ocular surface. Keratoprosthesis is required to restore visual function.

Keywords

• Stevens-Johnson syndrome
• Toxic epidermal necrosis
• drug reactions
• amniotic membrane transplantation