Acute and Chronic Ophthalmic Involvement, Severity, and Sequelae in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
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Purpose: To study the ocular manifestations, its severity and sequelae in patients with Stevens-Johnson syndrome (SJS) andtoxic epidermal necrolysis (TEN). Methods: Prospective study of 44 consecutive patients (30 SJS and 14 TEN) presenting in the acute phase of the disease. Patients were evaluated by dermatologist as well as physician for systemic status, skin lesions and mucosal involvement. Detailedhistory taking, visual acuity, ophthalmic evaluation (lid margin, corneal, conjunctival changes, tear film and ocular surface). Ocular severity score (OSS) was assessed at baseline (acute) and at 6 months (chronic / OSS6), graded as mild, moderateand 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 common causative factor (95.4%). At base line mild, moderate, andsevere 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 significant correlation between age of the patient and OSS at 6 months (p = 0.02). Younger agehad higher chronic OSS. Patients with TEN had higher acute (p = 0.001) and chronic (p = 0.001) OSS than SJS. Three mucosalsurface involvement associated with higher acute and chronic OSS (p = 0.001). No long-term ocularcomplications observedin 27 / 65 (41.5%) eyes. Acute OSS correlated significantly with chronic OSS, at 1 and 6 months (p = 0.001). Conclusions: Greater severity of the disease, more number of mucosal surfaces involved and shorter symptom lag correlatedwith more severe acute and chronic ocular manifestations. The severity of lid margin involvement and corneal involvement inacute stage were good predictors of severity of chronic ocular findings. Initial severity of ocular involvement correlated withseverity of ocular sequelae.
Abstract
Purpose: To study the ocular manifestations, its severity and sequelae in patients with Stevens-Johnson syndrome (SJS) andtoxic epidermal necrolysis (TEN). Methods: Prospective study of 44 consecutive patients (30 SJS and 14 TEN) presenting in the acute phase of the disease. Patients were evaluated by dermatologist as well as physician for systemic status, skin lesions and mucosal involvement. Detailedhistory taking, visual acuity, ophthalmic evaluation (lid margin, corneal, conjunctival changes, tear film and ocular surface). Ocular severity score (OSS) was assessed at baseline (acute) and at 6 months (chronic / OSS6), graded as mild, moderateand 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 common causative factor (95.4%). At base line mild, moderate, andsevere 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 significant correlation between age of the patient and OSS at 6 months (p = 0.02). Younger agehad higher chronic OSS. Patients with TEN had higher acute (p = 0.001) and chronic (p = 0.001) OSS than SJS. Three mucosalsurface involvement associated with higher acute and chronic OSS (p = 0.001). No long-term ocularcomplications observedin 27 / 65 (41.5%) eyes. Acute OSS correlated significantly with chronic OSS, at 1 and 6 months (p = 0.001). Conclusions: Greater severity of the disease, more number of mucosal surfaces involved and shorter symptom lag correlatedwith more severe acute and chronic ocular manifestations. The severity of lid margin involvement and corneal involvement inacute stage were good predictors of severity of chronic ocular findings. Initial severity of ocular involvement correlated withseverity of ocular sequelae.
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