Challenges in Managing the Ocular Complications of Stevens-Johnson Syndrome in Patients with Co-Existent Auto-Immune Disease.

Purpose: To describe the clinical course and management challenges of chronic ocular complications in Stevens-Johnson syndrome (SJS) patients with co-existing autoimmune diseases, emphasizing the role of systemic immunomodulatory therapy (IMT) in controlling inflammation and preventing disease progression.

Method: Two cases of chronic ocular SJS with underlying autoimmune diseases are described. Both patients experienced recurrent ocular inflammation, conjunctival scarring, and progressive limbal stem cell deficiency. They were managed with systemic IMT, including corticosteroids, mycophenolate mofetil (MMF), azathioprine, intravenous immunoglobulin (IVIG), cyclophosphamide, and rituximab. Disease progression, treatment response, and outcomes were assessed over a year follow-up.

Result: Both patients had recurrent ocular inflammation despite initial management with corticosteroids and conventional immunosuppressives. The introduction of MMF combined with rituximab successfully stabilized inflammation and ocular surface integrity in both cases. Long-term IMT was necessary to maintain ocular stability and prevent progressive ocular surface failure.

Conclusion: Chronic ocular complications of SJS require tailored immunosuppressive strategies, particularly in patients with preexisting autoimmune diseases. Early identification of disease patterns and co-management with rheumatologists are crucial. Rituximab and MMF may provide long-term disease control, but discontinuation of IMT should be approached cautiously to prevent recurrence. Further research is needed to optimize treatment protocols and determine the ideal duration of systemic therapy in chronic ocular SJS.