Acute Ocular Manifestations and Long-term Ocular Complications of Stevens Johnson Syndrome Pattern in Thammasat University Hospital

Abstract

ABSTRACT

Objectives

The objectives of this study are  to identify the acute and chronic ocular manifestations and severity of acute ocular involvement of Stevens-Johnson syndrome (SJS) and Toxic epithelial necrolysis (TEN) in Thammasat university hospital.

Methods

We did a retrospective study by chart review of  patients with  confirmed dermatological diagnosis of Stevens-Johnson syndrome and Toxic epithelial necrolysis with ocular involvement. The data were recruited from a database of Thammasat Universty Hospital. 30 consecutive patients diagnosed between June 2013 and May 2018 were recruited. We reviewed age, sex, causes of the disease process, acute ocular complications, acute symptoms, visual acuity, and late ocular complication. We used Darren G Gregory’s new grading system for identify the severity of acute manifestation of SJS and TEN.

Results

There were 30 consecutive patients. All were drug-induced. Antibiotics were the most commonly implicated group of drugs in this series (36.6%), followed by antiepileptic drugs (23.3%). The severity of acute ocular involvement was mild in 30%, moderate in 36.6% , severe in 13.3% and extremely severe in 20% of patients. Dry eye was the most common late complication (66.7%) following by punctate epithelial erosion (58.3%) and trichiasis (41.7%). Two patients had visual loss (16.6%).

Conclusions

         Ocular manifestations occurred in a high proportion of patients with SJS/TEN during both acute and late phase. The most common cause were antibiotic and antiepileptic drugs. A careful medication history should be obtained from these patients. Ophthalmic evaluation, and management are mandatory.