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.
References
- AHMED AR, Dohl MV. Con sen statement on the use of intravenous immuno globulin therapy in the treatment of autoimmune muco cutaneous blistering disease. Arch Dermatol Aug: 2003; 139 (8); 1051-9 (medicine)
- Ash by DW, LAZART, Erythema, multiforma exudativim major (Steven-Johnson-Syndrome). Lancet 260 – 1091 – 1095 (1951)
- Artz CP, RIHEN BURY MS, YARBROY gh DR, An appraisal of Allografts and xenografls as biological dressing for wounds and burns.
- Bastiji Garini S1, R2ANYB. Stern R.S. Shear N.H., Naldi L : Rovjeaie J.C. Clinical classification of case of Toxic epidermal neirolysis steven – Johnson syndrome and crythema multiforme Arch Dermatol 1993 : 129 – 90-96 Ann surg 175: 934-938, 1972
- Chan LS et al ocular cicatricial pemphigoid occurring as a sequel of SJS. JAMA 1991-266: 1543
- Chung WH, Huang SI, Hong HS, et al Capril 2004 “Medical genetics a marker for Steven-Johnsons Syndrome nature 428 (6982) 486.
- Duggan J.W Gaines S.R the ocular complications of erythema exudation multiforme A mer J, Ophthal 1951: 34/1; 189-197.
- ROJAS MV, Dart JK, SAW VP. The natural history of Steven Johnson syndrome. Patterns of chronic ocular disease and the role of systemic immuno suppressive therapy: Br.J.Ophthalmol 2007; 91(8): 1048-1053.
- Dohlman CH, Dough man DJ, the Steven Johnson syndrome: Trans New Ore leans A cad ophthalmol 24:236-252, 1972
- Dipascuate MA, Espana EM, Liv DT et al correlation of corneal complications with eyelid cicatricial pathologies in patients with Stevens Johnson syndrome and toxic epidermal neirolysis syndrome ophthalmology 2005: 112:904-12
- Duan’s clinical ophthalmology revised edition Lipp IN cort 1996 vol 4 ch2:45, vol 4 ch15: 41-42, vol 5 ch 27: 10-13
- Fitz Patrick T.B. Eisen A.W; Wolff K: Freedberg IM; Austen KF;L, Dermatology in general Medicine Fourth edition MC Graw Hill. Inc; 1993 vol 1: 586-1680
- Hallgren J, Tengvall-Linder M, Wahlgren CF, Steven Johnson syndrome Associated with ciprofloxacin: a review of adverse cutaneous events reported IN Sweden as associated with this drug.J AM Acad Dermatol Nov.2003; 49(5Supple): S267-9
- Howard GM, The SJS ocular prognosis and Ry. Amer J ophthal 1963:55:893-900)
- Kinoshita S et al: Long term result of kerato epithelio plasty IN moorens Ulcer ophthalmology 98: 438-445 (1991)
- Lehman SS, leny term ocular complications of SJS clINpediatr (Phila) 9999; 38: 425-7
- Lee Mutaphong V, Sivaja thorn A, Suthipinitharm P.Sunthonpalin P, Steven Johnson and toxic epidermal neurolysis IN Tailand:int J Dermatol 1993; 32:428-431
- Mockenhaupt M; missenheimer J, Tennis P, Schlingmann J, Risk of SJS and Toxic epidermal necrolysis in new users of antiepileptic’s, Neurology Apr.12 2005:04(7): 1134-8 (Medicine)
- Nelson JD, Wright JC congenital goblet cell densities IN ocular surface disease Arch.ophthalmol 1984: 102:1049-51
- M, ohmi G, Kiritoshi A, Kinoshita S, Goblet cell densities in ocular surface disease. Arch ophthalmol 1984: 102:1049-51
- Ormerod L-D: FONG L-P. Foster C.S: corneal infection in mucosal scarring disorders and SJo grens syndrome AM J ophthalmol 1998: 105: 512-518
- PATZA: ocular involvement in erythema multiforme. Arch.oph.1950:43:244-256.
- PohloJA S and Hors manfleimo A Keratinitis Sicca After erythema exudativum multiforme caused by PAS (case report) Acta ophthalmologica 1966:44; 415-419
- Power WJ, GHoraaishi M, Merayo, Lloves J, Neves RA, Foster CS. Analysis of acute ophthalmic manifestation of erythema multiforme/SJS/Toxic- epidermal Necr-olysis disease spectrum ophthalmology 1995: 102-1669-76 (PUBMED)
- RALPHRA, conjunctival goblet cell density in normal subjects and in dry eye syndrome investophthalmol via Sci 14: 299-302. 1975
- Roujeaie JC: Kelly JPNAldi L et al Medication use and the risk of steven-Johnson syndrome or Toxic epidermal neurolysisNEngi J med 1995:24; 1600-1607.
- Roujeaie M, Guillamine J.C, Fabre JP: Penso D: flechet M: Girre JP. Toxic epidermal necrolysis (Iyell syndrome) incidence and drug etiology IN France 1981-1985 (see comments) arch Dermatol 1990 JAN 126 (1): 37-42.
- Schop f E: S tuhmer A; RZAny B; Victor N Zentgruf R:KappJF: Toxic epidermal necrolysis and SJS: an epidemiologic study from west Germany arch Dermatol 1991 Jun 127 (6): 839-842
- SorenJensis A case of SJS following Antiepileptic medication acta ophtha-lmoplegica 1967:45:576-581
- TASMAN W: Jaegar EA. Duane’s Clinical ophthalmology: Revised edition LippinCort-Raven 1996: Volv 4 ch 2:45, valu 4.ch 15:41-42, Vol 5:ch. 27:10-13
- TING HC: AdAM BA: Steven Johnson syndrome a review of 34 cases int J Dermatol 1985 November 24(9); 587-591
- Ward K.E: Archanboult R; mersfidder T.L (2010) “severe adverse reactions to non-steroidal Anti inflammatory drug. A review of the literatrue “American Journal of health system pharmacy 67(B) 206-213, doic: 1021461 /ajhpo80603 PMD 2010 1062. Edit
- Wikins J, Morrison.L white CR, oculocutaneous manifestation of the erythema multiforma Steven Johnson syndrome Toxic epidermal necrolysis spectrum dermatology clinics 1992 July:10(3) 571-582
- YIPlw THONG By-Lum J et al ocular manifestation and complications of Steven Johnson syndrome and Toxic epidermal neurolysis. An Asian series Eyo 2005: 19:846-53.
Corresponding Author
Dr S. Remadevi
RIO, Thiruvananthapuram Mch