Acute and Chronic Management of Ocular Disease in Stevens Johnson Syndrome/Toxic Epidermal Necrolysis in the USA.

Derek Metcalfe,James Chodosh,Omer Iqbal,Charles S. Bouchard,Hajirah N. Saeed

doi:10.3389/fmed.2021.662897

Abstract

Stevens Johnson syndrome and toxic epidermal necrolysis are on a spectrum of a severe, immune-mediated, mucocutaneous disease. Ocular involvement occurs in the vast majority of cases and severe involvement can lead to corneal blindness. Treatment in the acute phase is imperative in mitigating the severity of chronic disease. Advances in acute treatment such as amniotic membrane transplantation have shown to significantly reduce the severity of chronic disease. However, AMT is not a panacea and severe chronic ocular disease can and does still occur even with aggressive acute treatment. Management of chronic disease is equally critical as timely intervention can prevent worsening of disease and preserve vision. This mini-review describes the acute and chronic findings in SJS/TEN and discusses medical and surgical management strategies.

Highlights

OverviewStevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe and potentially lethal multisystem, mucocutaneous, immune-mediated, adverse drug reactions (IM-ADR), with significant long-term ocular and systemic morbidity [1,2,3,4,5,6]
Better visual acuity and reduced incidence of corneal haze, limbal stem cell deficiency (LSCD), symblepharon, ankyloblepharon, or eyelidrelated complications have been reported in the long-term (17, FIGURE 1 | Ocular surface involvement in acute SJS/TEN and severe chronic SJS/TEN. (A) Acute conjunctival hyperemia and membrane. (B) Acute eyelid margin sloughing as evident with fluorescein staining under cobalt blue light. (C) Acute corneal epithelial defect stained with fluorescein. (D) Chronic dense corneal neovascularization and opacity in a wet, blinking eye
It is important to note that AMT is not a panacea and severe chronic disease can still occur despite aggressive acute phase treatment and all SJS/TEN patients must be followed closely for the development of complications [17, 23]

Summary

Introduction

OverviewStevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe and potentially lethal multisystem, mucocutaneous, immune-mediated, adverse drug reactions (IM-ADR), with significant long-term ocular and systemic morbidity [1,2,3,4,5,6]. TREATMENT STRATEGY FOR SJS/TEN WITH SEVERE OCULAR COMPLICATIONS IN THE ACUTE STAGE (0–6WEEKS) Resolution of conjunctival injection, epithelial defects, and eyelid margin ulceration are signs of resolution of acute disease.

Results

Conclusion