The Skin and the Eyes

The natural history of Stevens Johnson syndrome: patterns of chronic ocular disease and the role of systemic immunosuppressive therapy

“…Severe SJS was present in seven patients (cases [5][6][7][8][9][10][11], in at least one eye, at presentation and remained stable throughout their follow-up.…”

“…SJS-MMP developed in 5 patients (10 eyes (16.6%)). The median duration from the acute stage to the diagnosis of SJS-MMP was 2 years (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Immunosuppressive therapy successfully controlled inflammation in 10/10 patients with SJS-MMP, SJS-RI or SJS-S.…”

“…The chronic complications have different aetiologies and may co-exist or occur sequentially in the same patient. 6 Whereas a subset of patients have mild ocular involvement, other patients present with severe complications early after the acute stage, caused by conjunctival scarring. 1-5 A major cause of chronic disease is stem cell failure (ocular surface failure in SJS (SJS-OSF)).…”

Medial canthal area reconstruction with horizontal advancement flap

“…Over 70% occur on the lower eyelid followed in order of frequency by the medial canthus, upper eyelid and lateral canthus (1). Although these tumors rarely metastasize, they present a challenge to the dermatologic surgeon, since this is an area of major surgical stress; these tumors are often associated with incomplete excision, high rates of recurrence, leading to more aggressive surgical sequelae, and the medial canthal region represents the most difficult periorbital zone to reconstruct (2).…”

“…If left untreated, these tumors tend to infiltrate deeply, because of local anatomy. The lacrimal sac and the rich anastomosis of blood vessels offer little resistance to deep invasion (1). Once the orbital septum is penetrated, the BCC can rapidly invade the orbit (1) and in rare cases, reach the frontal lobes through ethmoid cells (3).…”