Ocular Sequelae Research Articles

Severe toxoplasmosis imported from tropical Africa in immunocompetent patients: A case series.

Toxoplasmosis is a zoonosis caused by the protozoan Toxoplasma gondii. In immunocompetent patients the infection is usually benign. However, cases of severe and even lethal primo-infections are regularly reported in South America. In contrast, data from tropical Africa are fragmentary. Data for French cases of severe toxoplasmosis acquired between 2013 and 2018, in tropical Africa and among immunocompetent patients were collected retrospectively in 2018. Four male patients with a mean age of 34-years were identified. All infections originated in West or Central Africa. The clinical presentations were heterogeneous: two patients had severe disseminated toxoplasmosis, of which one presented with chorioretinitis associated with myositis and the other with febrile pneumopathy; one patient presented with post-infectious acute cerebellar ataxia and the final case had general symptoms and skin manifestations. The diagnosis of acute toxoplasmosis was confirmed by serology in four patients. Molecular diagnosis confirmed T. gondii infection in three patients with Africa 1 as the dominant genotype. The infection was cured with anti-infective treatment in all four patients. Ocular sequelae were reported in the two patients with chorioretinitis. Imported cases of severe toxoplasmosis in immunocompetent patients are rare in France. However, this aetiology should be evoked rapidly in a patient with a severe infectious syndrome who has recently visited or originated from tropical Africa.

Management of ocular manifestations of autosomal recessive congenital ichthyosis 4B, harlequin type, in the perinatal period

Autosomal recessive congenital ichthyosis (ARCI4B [OMIM #242500]), also known as harlequin ichthyosis, presents at birth with extreme hyperkeratosis and thick-fissured plaques, leading to tightness of the skin around the eyes, mouth, ears, chest, abdomen, and extremities. Ocular manifestations include cicatricial ectropion and exposure keratitis. We present 2 infants with ARCI4B and cicatricial ectropion who were managed with aggressive nonsurgical therapy. Both infants avoided severe ocular sequelae and maintained corneal clarity, highlighting that management of exposure keratopathy with frequent ophthalmic ointment application can prevent severe ocular surface pathology in ARCI4B.

Periocular infantile hemangiomas: Characteristics, ocular sequelae, and outcomes.

To identify clinical factors associated with complications of periocular infantile hemangioma (IH) and monitor improvement in complication rates post-treatment. Retrospective cohort study. Eighty-nine patients diagnosed with periocular IH at a pediatric dermatology clinic of a tertiary care center between 2001 and 2013 were included with parental approval. Parents were interviewed by telephone between July and September of 2015, then again in January 2018 to inquire about ophthalmologic follow-up. Electronic medical records were reviewed from January 2001 through January 2018. Sixty percent of patients demonstrated ocular sequelae, including astigmatism (33%), visual axis obstruction (29%), nasolacrimal duct obstruction (7%), ptosis (4%), amblyopia (3%), and strabismus (1%). Compared with superficial IH, deep and mixed IH had higher odds, 3.4 (P=0.025) and 3.8 (P=0.034), respectively, of developing ocular sequelae. All patients with astigmatism prior to involution of IH received systemic therapy, with a significant post-treatment decrease in the proportion of patients with astigmatism (40% to 18%, P=0.027). Three-quarters of patients experienced complete IH involution by time of enrollment in kindergarten. Fifty-one (57.3%) patients received formal ophthalmologic evaluation confirmed through chart review or phone interview, with average follow-up duration of 51.2months (range: 1.9, 99.3). Deep and mixed IH were more likely to demonstrate ocular complications than superficial IH. Rate of astigmatism decreased with systemic therapy. Our study suggests that patients with periocular IH have a lower rate of amblyopia now compared with the prepropranolol era and emphasizes the importance of early treatment of periocular IH to prevent permanent visual sequelae.

Ocular Sporotrichosis: 26 Cases with Bulbar Involvement in a Hyperendemic Area of Zoonotic Transmission

ABSTRACT Purpose To describe 26 cases of bulbar conjunctival sporotrichosis. Methods Review of clinical records of patients with bulbar conjunctivitis due to culture-proven Sporothrix spp. infection, in Rio de Janeiro, from 2007 to 2017. Results Twenty-six patients were identified. Median age was 25 years. Adults were more affected (53.8%), followed by adolescents (26.9%). There was a predominance of women (73.1%). Twenty-four patients (96%) reported contact with cats with sporotrichosis. Twenty-one patients (80.8%) presented a primary ocular sporotrichosis. Five patients presented associated eyelid lesions, and 21 (80.8%) tarsal conjunctivitis. Parinaud oculoglandular syndrome was observed in 17 (81%) patients. Eight patients (36.4%) reported the use of steroid drops before diagnosis was made. All patients but one were treated with oral itraconazole. Twenty-three patients (88.5%) were completely cured and three (11.5%) were lost to follow-up. Eight patients (34.8%) developed ocular sequelae. Conclusion Bulbar conjunctivitis is an important clinical presentation of ocular sporotrichosis. It can lead to ocular sequelae. Sporotrichosis should be considered in the differential diagnosis of ophthalmic external diseases, especially in patients with cat contact history

The bee sting and the eye: A case report of an ab-externo sting removal technique

Bee stings are a rare form of ocular trauma with the ocular sequelae attributable to the mechanical effects of the stinger as well as the inflammatory and neurotoxic effects of the venom. This research reports on a case of a retained corneal bee stinger and the technique used for removal of the stinger. This case report is of a patient that presented with a retained corneal bee stinger to St John Eye Hospital, Soweto. A 45-year-old male presented with a retained bee sting in the anterior chamber angle of the eye. A combination ab-externo technique was used to remove the sting. We present the case of a honey bee sting to the cornea that was removed using an ab-externo technique to maintain globe integrity and preserve vision.

Prevalence and clinical features of orbital vascular anomalies in children

While vascular anomalies have been reported to occur in up to 1% of children, there are no population-based studies describing the prevalence of orbital vascular anomalies. The purpose of this study was to report the birth prevalence, demographics, and ocular sequelae of orbital vascular anomalies diagnosed in children over a 50-year period.

Ocular Manifestations of Sickle Cell Disease: A Review

Problem: Sickle cell disease (SCD) is an increasingly frequent global health concern whose complications may result in decreased function and reduced quality of life. SCD is a multisystem monogenic disease resulting from a mutation that causes the abnormal ‘sickling’ of erythrocytes. Subsequent local and diffuse vaso-occlusion can cause both systemic and ocular damage. Although sickle cell retinopathy (SCR) is the most commonly evoked ocular sequelae of SCD, all vascularized ocular tissues can become ischemic and progressively damaged. The combination of retinal screening of high-risk patients and early detection of the ocular sequelae of SCD with advanced diagnostic technologies should result in timely intervention and preservation of vision. Conclusion: This review of the ocular manifestations of SCD will reinforce the critical role of optometry in the multi-disciplinary care of these growing number of patients we as a profession will encounter. CE Notification: This article is available as a COPE accredited CE course. You may take this course for 2-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/ocular-manifestations-of-sickle-cell-disease-a-review) Please check COPE course expiry date prior to enrollment. The COPE course test must be taken before the course expiry date.

Evaluating Dry Eye and Meibomian Gland Dysfunction With Meibography in Patients With Stevens-Johnson Syndrome.

To investigate ocular surface and meibomian gland characteristics using infrared meibography in patients with Stevens-Johnson syndrome (SJS). This is a single-center, prospective, noncontrolled, observational study. Thirty-two Thai patients (64 eyes) with SJS for 1 year or longer (1-44 years) were enrolled in the study. All participants underwent a comprehensive ophthalmic examination including slit-lamp biomicroscopy, tear meniscus height, fluorescein tear breakup time, ocular surface fluorescein staining, eyelid morphology, Schirmer 1 test, meibomian gland expressibility, and upper and lower eyelid meibography using a noncontact infrared meibograph mounted on a slit-lamp biomicroscope. The mean age was 42.2 ± 17.7 years (range, 4-68 years). Twenty-nine patients (90.6%) had a history of severe ocular complications in the acute stage of the disease. Medications were the most common cause of SJS (93.8%). Meibum quality could not be assessed in 23 patients (71.9%) due to no glands expressible. Partial or complete loss of the meibomian glands in either the upper or lower eyelid was found in all patients. The degree of meibomian gland dropout significantly correlated with tear breakup time (P < 0.001), meibum quality (P < 0.001), meibum expressibility (P < 0.001), ocular surface staining (P < 0.001), and presence of long-term ocular sequelae including symblepharon (P = 0.027) and limbal stem cell deficiency (P = 0.003). SJS is associated with obstructive meibomian gland dysfunction. The severity of meibomian gland dropout has a relationship with abnormal dry eye tests, subjective meibomian gland evaluation, and other ocular sequelae of SJS.

Altered retinoid metabolism gene expression in chronic Stevens-Johnson syndrome

BackgroundStevens-Johnson syndrome (SJS), a blistering disorder of the skin and mucous membrane, leads to ocular morbidity in >60% of cases. Retinoids are vital micronutrients for vision, regulating corneal and conjunctival...

Multistep Grading System for Evaluation of Chronic Ocular Sequelae in Patients With Stevens-Johnson Syndrome

To propose a new scoring system for grading of chronic ocular sequelae in Stevens-Johnson syndrome (SJS). Reliability and validity analysis. Participants: Four hundred eyes of 200 patients with chronic ocular SJS/toxic epidermal necrolysis (TEN) were included in the study. Single-center, tertiary eye care referral center. All patients with SJS/TEN with chronic (more than 1 year) ocular sequelae were recruited for the study. Corneal, eyelid, and conjunctival signs were evaluated and given scores ranging from 0 to 5 depending on the increasing severity. Twelve signs (6 corneal, 3 conjunctival, and 3 eyelid) were evaluated to obtain the total severity score for each eye. Based on the corrected distance visual acuity (CDVA) and total score, each eye was graded using receiver operating characteristic (ROC) analysis. Correlation of CDVA with the severity score determined on the basis of 12 corneal, eyelid, and conjunctival signs. Mean age was 24.09 ± 10.9 years. The most common inciting agent for SJS was oral medications (85%). The scores of 12 ocular surface parameters correlated significantly with CDVA (P < .001). ROC analysis revealed 4 grades of total severity score of 0-11 (stage 0), 12-16 (stage 1), 17-22 (stage 2), and 23-53 (stage 3). The total severity score correlated significantly with logMAR visual acuity grades with an agreement of 60.7% using Cohen's kappa analysis (kappa coefficient= 0.420 ± 0.03). The most common stage of total severity score was stage 3 in 49% of eyes (196/400), followed by stage 0 (107/400, 26.7%). The multistep scoring system of chronic ocular features in SJS/TEN sequelae is a useful tool to grade all levels of severity. This may help to evaluate the efficacy of the surgical intervention by comparing preoperative with postoperative ocular grades.

Ocular and Mucocutaneous Sequelae among Survivors of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Togo.

Aim The aim of this study was to assess ocular and mucocutaneous sequelae among SJS/TEN survivors and identify risk factors of ocular sequelae. Patients and Method Late complications among SJS/TEN survivors were assessed using 2 methods: a retrospective assessment of medical records only or a retrospective assessment of medical records and physical examination of survivors who were contacted by phone. Results Between January 1995 and December 2017, 177 cases of SJS/TEN (138 cases of SJS, 29 cases of TEN, and 10 cases SJS/TEN overlap) were admitted into two university hospitals of Lomé (Togo). There were 113 women and 64 men, with an average age of 31.7±13.0 years (range: 5 to 80 years). The most used drugs were antibacterial sulfonamides (35.6%) and nevirapine (24.3%). HIV serology was positive in 68 (59.1%) of the 115 patients tested. Sixty-four (52,5%) of the 122 patients, who had been examined by an ophthalmologist during the acute stage, had acute ocular involvement, which was mild in 27.9% of patients, moderate in 13.1%, and severe in 11.5%. We recorded 17 deaths (i.e., three cases of SJS, 12 of TEN, and two of SJS/TEN overlap), including 11 cases of HIV infected patients. Of the 160 SJS/TEN survivors, only 71 patients were assessed 6 months after hospital discharge. Among them, forty-three (60.6%) patients had sequelae. Concerning mucocutaneous sequelae, the main lesions were diffuse dyschromic macules (38.0% of patients) and ocular sequelae were dominated by decreased visual acuity (14.1% of patients). In multivariate analysis, exposure to sulfadoxine (odds adjusted ratio = 5.95; 95%CI= [1.36-31.35]) and moderate (adjusted odds ratio = 5.85; 95%CI = [1.23-31.81]) or severe (adjusted odds ratio = 48.30; 95%CI = [6.25-1063.66]) ocular involvement at acute stage were associated with ocular sequelae. Conclusion Ocular and mucocutaneous sequelae are common in SJS/TEN survivors. Exposure to sulfadoxine and severity of acute ocular involvement are risk factors of ocular sequelae.

Consensus on the treatment of autoimmune bullous dermatoses: bullous pemphigoid, mucous membrane pemphigoid and epidermolysis bullosa acquisita - Brazilian Society of Dermatology.

Bullous pemphigoid, mucous membrane pemphigoid and epidermolysis bullosa acquisita are subepidermal autoimmune blistering diseases whose antigenic target is located at the basement membrane zone. Mucous membrane pemphigoid and epidermolysis bullosa acquisita can evolve with cicatricial mucosal involvement, leading to respiratory, ocular and/or digestive sequelae with important morbidity. For each of these dermatoses, a literature review covering all therapeutic options was performed. A flowchart, based on the experience and joint discussion among the authors of this consensus, was constructed to provide treatment orientation for these diseases in Brazil. In summary, in the localized, low-risk or non-severe forms, drugs that have immunomodulatory action such as dapsone, doxycycline among others may be a therapeutic option. Topical treatment with corticosteroids or immunomodulators may also be used. Systemic corticosteroid therapy continues to be the treatment of choice for severe forms, especially those involving ocular, laryngeal-pharyngeal and/or esophageal mucosal involvement, as may occur in mucous membrane pemphigoid and epidermolysis bullosa acquisita. Several immunosuppressants are used as adjuvant alternatives. In severe and recalcitrant cases, intravenous immunoglobulin is an alternative that, while expensive, may be used. Immunobiological drugs such as rituximab are promising drugs in this area. Omalizumab has been used in bullous pemphigoid.

Ophthalmological perspectives of toxic epidermal necrolysis

Toxic epidermal necrolysis (TEN) is as rare as two cases per million per year, but the ocular manifestations and sequelae are very severe. We present a case series of seven patients admitted to the intensive care unit in a tertiary hospital with a diagnosis of TEN describing the extent of ocular involvement, its response to treatment, and appearance of sequelae. All seven were drug-induced with moderate-to-severe skin, mucosal, ophthalmic involvement, and systemic involvement. Ocular findings on presentation were eyelid skin detachment, adherent lid margins, bilateral mucopurulent conjunctivitis with inflammatory membranes, and punctate epithelial keratitis in all patients. Large persistent corneal epithelial defect was seen in four patients. On follow-up, five had severe keratoconjunctivitis sicca and entropion with trichiasis. Photophobia was the major debilitating sequelae. Early management was the key to reduce severity, cicatrization, and sequelae. Corticosteroids topically and systemically, topical cyclosporine, and lubricants were the mainstay of management.

Epidermal necrolysis: SCORTEN performance in AIDS and non-AIDS patients

Background Stevens-Johnson syndrome and toxic epidermal necrolysis are life-threatening blistering drug reactions with high incidence of ocular sequela. The term ‘Epidermal Necrolysis’ has been recently used to better describe the full spectrum of the disease that includes Stevens-Johnson syndrome and toxic epidermal necrolysis at opposite ends, which differ by the extent of body surface area with epidermal detachment. SCORTEN is a mortality prognosis score for ‘Epidermal Necrolysis’ cases that still needed validation in acquired immunodeficiency syndrome.Objective To evaluate the SCORTEN performance in acquired immunodeficiency syndrome, and the differences in outcomes between acquired immunodeficiency syndrome and non- acquired immunodeficiency syndrome cohorts.Methods Retrospective cohort study of AIDS and non-AIDS ‘Epidermal Necrolysis’ cases admitted to a Brazilian reference center from 1990-2014.Results Five deaths (16.7%) occurred as a consequence of EN in 30 AIDS patients, and seven (17.9%) in 39 non-AIDS patients, relative risk (RR) .92 (p=1.0). SCORTEN showed great performance, with an Area Under the Receiver Operating Curve (AUC) (ROC) of 0.90 with a 95% confidence interval ranging from .81 to .99. The performance of SCORTEN was better among non-AIDS patients than AIDS patients: AUC non- acquired immunodeficiency syndrome =0.99 (CI 05% 0.96-1.00), AUC acquired immunodeficiency syndrome = 0.74 (CI 95% 0.53-0.95), p=.02.Study Limitations: Heterogeneity of cases, wide variation of systemic corticosteroid doses when used.Conclusion: SCORTEN is valid for the Brazilian population, including among those patients with acquired immunodeficiency syndrome, and, as such, its use is recommended for aiding treatment choice in this subgroup of patients.

Vision-related quality of life in children with treated retinopathy of prematurity.

Purpose:To evaluate vision-related quality of life in children treated for retinopathy of prematurity.Methods:Cross sectional observational study of 54 treated ROP babies 2–7 years of age. The study excluded babies with chronic pediatric conditions and babies of parents suffering from mental illness. Detailed examination including visual acuity was done for all. Two versions of CVFQ questionnaire for children under 3 and above 3 years of age were posed to parents in this study. CVFQ contains six subscales: General health, vision health, competence, personality, family impact, and treatment difficulty. The scores ranged from 0 (worst score) to 1 (best score).Results:The study included 54 children with mean birth weight was 1194 grams, mean gestation age 30 weeks. The age, gender, birth weight, and gestational age didn’t affect the overall quality of life (P > 0.05). The severity of ROP (stage 4 and 5) had poorer CVFQ scores (personality and family impact subscales). Competence and personality scores were significantly lower in zone I disease. The quality of life especially general vision, competence, personality, and treatment difficulty subscales had significantly lower values in ROP with higher clock hour involvement (P < 0.05). With myopia after ROP treatment, only personality subscale was significantly affected (P 0.02). Mean CVFQ score including the family impact and treatment difficulty subscale score was also significantly lower in amblyopic and anisometropic children (P value < 0.05). Family impact subscale and overall quality of life was significantly lower in children with strabismus than children without strabismus (P 0.001).Conclusion:ROP has negative effect on the vision-related quality of life of children and their parents. The overall quality of life worsened with the increase in the severity of disease and the occurrence of ocular sequelae of ROP. The vision of the baby may not be the only cause of low scores in the quality of life questionnaire in ROP.

Targeted deletion of fibrillin-1 in the mouse eye results in ectopia lentis and other ocular phenotypes associated with Marfan syndrome.

ABSTRACTFibrillin is an evolutionarily ancient protein that lends elasticity and resiliency to a variety of tissues. In humans, mutations in fibrillin-1 cause Marfan and related syndromes, conditions in which the eye is often severely affected. To gain insights into the ocular sequelae of Marfan syndrome, we targeted Fbn1 in mouse lens or non-pigmented ciliary epithelium (NPCE). Conditional knockout of Fbn1 in NPCE, but not lens, profoundly affected the ciliary zonule, the system of fibrillin-rich fibers that centers the lens in the eye. The tensile strength of the fibrillin-depleted zonule was reduced substantially, due to a shift toward production of smaller caliber fibers. By 3 months, zonular fibers invariably ruptured and mice developed ectopia lentis, a hallmark of Marfan syndrome. At later stages, untethered lenses lost their polarity and developed cataracts, and the length and volume of mutant eyes increased. This model thus captures key aspects of Marfan-related syndromes, providing insights into the role of fibrillin-1 in eye development and disease.

Ocular manifestations of leukaemia: A teaching hospital experience.

Knowledge of the ophthalmic manifestations of leukaemia is important not only because of the frequency with which changes are seen but because the eye often reflects the disease state of the illness, and once identified, prompt referral, early treatment can be instigated, blindness can be averted and a life may be saved. These manifestations are often overlooked because of the underestimation of the magnitude of the ocular sequelae which may be blinding. This study aims to describe the ophthalmic findings in adult leukaemic patients at two teaching hospitals in Lagos, Nigeria. This was a clinic-based, comparison multicentre study conducted at Lagos University Teaching Hospital and Lagos State University Teaching Hospital over a 9-month period of May 2012-January 2013. The cases were newly diagnosed leukaemic patients (acute and chronic) from the haematology clinics. Controls were escorts of apparently normal patients. Detailed ocular examination was carried out after written informed consent was obtained. Analysis was done using SPSS 17. A total of 160 eyes in 80 individuals examined comprised forty cases and forty controls. The results of the cases were compared with the age- and sex-matched controls. Leukaemic-related ophthalmic manifestations were present in 56 eyes (70.0%) of the cases studied. Findings in cases were periorbital oedema in 8 eyes (10%), subconjunctival haemorrhage in four eyes (5%), intraretinal haemorrhage as found in 25 eyes (31.3%), retinal venous tortuosity in 21 eyes (26.3%), Roth spots in 19 eyes (23.8%) and retinal infiltrates in 17 eyes (21.3%). Ophthalmic disorders occur in adult patients living with leukaemia. Prompt initial and periodic ophthalmic evaluation is recommended in all leukaemic patients.

Long-term efficacy of fractionated conformal radiotherapy for the management of primary optic nerve sheath meningioma

Background/AimFractionated conformal radiotherapy (FCRT) is now used to treat vision-threatening optic nerve sheath meningioma (ONSM), but long-term efficacy and safety data are lacking; the purpose of this study was to...

Seroprevalence of Toxoplasma gondii infection in mentally retarded children in Egypt

Background:Toxoplasmosis is one of the most common causes of latent infections in humans and animals. Its important clinical aspect is the probable danger of congenital transmission and its severe effects on the fetus. Infection is typically asymptomatic at birth, or is associated with serious neurological or ocular sequelae later in life with a broad spectrum of clinical presentations. Serologic screening detects acute infection in pregnant women which if unrecognized may be transmitted to the unborn. Objective:To investigateserologically the prevalence of toxoplasmosis as a hidden cause of mental retardation (MR) in a sample of children from urban and surrounding rural areas attending the New Children Hospital of Cairo University (Abu Reesh Hospital), Cairo. Materials and Methods: The present study was conducted on 200 children diagnosed as MR attending neurology outpatient clinics as a case group; and 200 samples as a control group fromnon-MR children attending other outpatient clinics with minor complaints like skin manifestations in dermatology clinic, upper respiratory infections and minor gastrointestinal complaints.Venous blood samples from the two groups of children were serologically tested for specific IgG by indirect hemagglutination test (IHAT). Relevant sociodemographic and clinical data related to the children and their mothers was collected using a designed sheet. Results: Our results showedthat the prevalence of toxoplasmosis in the MR children was significantly positive in 84/200 (42.0%) of the case group (P<0.001).The number of positive sera was 35/200 (17.5%) among control group. Associated clinical manifestations in the case group (MR) included convulsions in 53.5%, eye problems in 22.5%, splenomegaly in 16.5% and hepatomegaly in 9.5% of cases. There was no significant difference between urban and rural residences; and relevant risk factors in mothers included history of previous Toxoplasma infection (13.5%), history of abortion and still birth (each 36.5%) and premature deliveries (19.5%). History of contact with cats and consumption of undercooked meat rated 58% and 77.7% respectively. Conclusion: Screening females who are at risk for acquired toxoplasmosis is essential, before and during pregnancy to detect Toxoplasma seroconversion. Conversion from negative to positive testing would indicate exposure to infection, requiring the implementation of early treatment of infection to protect the unborn fetuses from trans-placental transmission.

Severe Dry Eye With Combined Mechanisms is Involved in the Ocular Sequelae of SJS/TEN at the Chronic Stage.

Stevens-Johnson syndrome (SJS), and its more severe variant, toxic epidermal necrolysis (TEN), are life-threatening diseases of the skin and mucous membranes. After the acute-stage damage subsides, serious visual impairment and severe dry eye remains as ocular sequelae. At the acute stage, ocular complications occur in 77% of SJS/TEN patients. In cases with pseudomembranous formation and/or epithelial defects, the risk of ocular sequelae increases. Among 13 slit-lamp microscopy images that we obtained of SJS/TEN patients at the chronic stage, the loss of corneal epithelial stem cells and severe meibomian gland involvement were found to be the most common disorders. Severe dry eye in SJS includes three important mechanisms: (1) aqueous tear deficiency, (2) decreased wettability of corneal surface, and (3) increased evaporation. Dry eye severity in SJS patients is often underestimated when the meniscus is first observed, as the punctum is closed due to scarring or surgery. In SJS patients with severe dry eye, the dryness results in immense eye pain, and unstable tear film related to dry eye result in a change/loss of vision. For the treatment of dry eye in SJS, it is important to suppress chronic inflammation on the ocular surface, and 2% rebamipide ophthalmic solution reportedly helps to obtain ocular surface stabilization. Scleral contact lenses, as well as the newly developed limbal-rigid contact lenses, improve the patients' visual acuity and reduce symptoms related to severe dry eye. Further studies and new therapeutic methods are needed to more effectively treat dry eye in patients afflicted with SJS/TEN.