Ocular Complications in stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Comprehensive Review.

Abstract

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis are rare but life-threatening mucocutaneous disorders, primarily triggered by adverse drug reactions. Although systemic manifestations have been extensively studied, ocular involvement remains a major cause of morbidity, often resulting in severe visual impairment or blindness.

Methods: This narrative review synthesizes current evidence regarding the clinical presentation, pathophysiology, and management strategies for ocular complications in SJS/TEN. A comprehensive literature search was conducted to highlight both acute and chronic ophthalmic manifestations and therapeutic interventions.

Results: Ocular involvement is reported in up to 75% of SJS/TEN patients during the acute phase, manifesting as conjunctivitis, pseudomembrane formation, corneal erosions, and eyelid abnormalities. Early interventions such as lubrication, topical corticosteroids, and amniotic membrane transplantation (AMT) have shown efficacy in mitigating long-term damage. Nonetheless, a substantial number of patients develop chronic complications including symblepharon, limbal stem cell deficiency, and severe dry eye syndrome. Long-term management involves scleral lenses and surgical procedures such as limbal stem cell transplantation, mucous membrane grafting (MMG), and keratoprosthesis. Innovations like ProKera® have improved epithelial healing, yet irreversible damage from the acute phase remains a persistent challenge.

Conclusion: Ocular complications of SJS/TEN are multifaceted and necessitate early and sustained multidisciplinary management. Timely ophthalmologic intervention is crucial in the acute phase, while chronic care aims to restore ocular surface stability and preserve vision. Further research is needed to develop standardized treatment protocols and explore emerging therapies that may enhance long-term outcomes and quality of life.