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Category: Volume 06 Issue 03 March 2018
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Title: Chronic Ocular Manifestation of Steven Johnson Syndrome along Southern Kerala, India

Authors: Dr S. Remadevi, Dr. Sheela Bhasker

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i3.70

Abstract

SJS causes mucosal erosions with wide spread erythematous. Cutaneous macular or target lesions than merge together with subsequent epidermal detachment General drug ethology of SJS and its ocular complications and their management was investigated in present study 52 SJS confirmed cases were studied prospectively at RIO TVPM and the data obtained were statistically analysed. The severity and chronicity of the eye complications depends to a large extent upon the degree of ocular damage during the acute syndrome. Even patient with milder skin involvement may still have severe ophthalmic involvements during the acute phase CHRONIC eye findings noticed are scarring, symblepharon, cicatrization of, conjunctivae, entropion, trichiasis distichiasis and tear film instability.  Break down of ocular surface leads to corneal scarring and neovascularisation also. Ectropion noticed may be due to severe mucosal injury leads to scarring of lids.  Development of ocular cicatrical pemphigoid : a chronic scarring and neovascularisation also. Ectropion noticed may be due to severe mucosal injury and leads to scarring of lids. Development of the ocular cicatrical pemphigoid a chronic scarring inflammation of the ocular mucosa can leads to blindness. The time interval between the onset of SJS and cicatrical pemphigoid ranges from few months to years. The entropion may be due to contraction of the palpebral conjunctivae. Madarosis due to loss of eye lashes. A more severe chronic problem such as tarsal conjuctival keratinisation may results in chronic keratopathy.

Symblepharm results from adhesion between tarsal and bulbar conjunctivae Late phase corneal complication may develop due to corneal exposure leading to superficial and punctuate epithelial keratitis, recurrent epithelial defect in growth of abnormal new blood vessels with vascularisation, corneal scarring, deep keratinisation corneal thinning and opacity in the visual axis leads to blindness and may corneal perforation results due to uncontrolled infection and leads to endophthalmitis and pan ophthalmitis that finally need evisceration or enucleation. Dry eye being also a late phase complication may develop in a high percentage of patients with SJS. Tear film deficiency may due to conjunctival xerosis or corneal xerosis. Early interference and active treatment regime can reduce the events and further extent of corneal involvement in this study.

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Corresponding Author

Dr S. Remadevi

RIO, Thiruvananthapuram Mch