Korean J Ophthalmol > Epub ahead of print
DOI: https://doi.org/10.3341/kjo.2020.0118    [Epub ahead of print]
Published online February 18, 2021.
Acute and chronic ophthalmic involvement, severity & sequelae in Stevens-Johnson syndrome and Toxic Epidermal Necrolysis
Sunil Ganekal1, Ashwini Nagarajappa2
1JJM Medical college, Davanagere, Karnataka, India, 577004
2JJM Medical college, Davanagere, Karnataka, India, 577004
Correspondence:  Sunil Ganekal, Tel: 91-8192-222565, 
Email: drgsunil@yahoo.com
Received: 17 September 2020   • Revised: 27 October 2020   • Accepted: 11 December 2020
Abstract
Purpose
To study the ocular manifestations, its severity and sequelae in patients with Stevens- Johnson syndrome (SJS) and Toxic epidermal necrolysis (TEN)
Methods
Prospective study of 44 consecutive patients (30 SJS and 14 TEN) presenting in the acute phase of the disease. All patients were evaluated by Dermatologist as well as physician for systemic status, skin lesions and mucosal involvement. Detailed history taking, visual acuity assessment, complete ophthalmic evaluation (lid margin, corneal, conjunctival changes, assessment of tear film and ocular surface).Ocular severity score (OSS) was assessed at baseline(acute) and at six months (chronic/OSS6) and were graded as mild, moderate and severe.
Results
Mean age was 28.15 ±15.78 years. Sixty five eyes of 33 patients were included for final analysis. Thirty eight patients (86.4%) had ocular manifestations. Drugs were the most commonly associated causative factor (95.4%). At base line mild, moderate and severe OSS was seen in 43.1%, 44.6% and 12.3% eyes. At 6 months mild, moderate and severe OSS was seen in 44.6%, 7.7% and 6.2% of eyes. There was a statistically significant correlation between age of the patient and OSS at 6 months (p = 0.02). Younger age group had higher chronic OSS. Patients with TEN had higher acute (p=0.001) and chronic (p=0.001) OSS than SJS. Shorter the time to onset of symptoms following drug intake correlated with higher OSS. Three mucosal surface involvements was associated with higher acute and chronic OSS (p= 0.001). There were no long term ocular complications observed in 27/ 65 (41.5%) eyes. The acute OSS correlated significantly with the chronic OSS, at 1 and 6 months (p =0.001).
Conclusion
Greater severity of the disease, more number of mucosal surfaces involved and shorter symptom lag correlated with more severe acute and chronic ocular manifestations. The severity of lid margin involvement and corneal involvement in acute stage were good predictors of severity of chronic ocular findings. Initial severity of ocular involvement correlated with severity of ocular sequelae.
Key Words: Stevens Johnson syndrome, Toxic epidermal necrolysis, Ocular manifestations, Ocular severity score
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