USA: Ophthalmologic Evaluation and Management of Acute Stevens-Johnson Syndrome

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) can cause significant damage to the ocular surface and eyelids. The sloughing and inflammation of the ocular mucosal epithelium during the acute phase may lead to scarring sequelae of the eyelids and ocular surface, resulting in pain and vision loss. Amniotic membrane transplantation (AMT) to the eyes and eyelids during the initial 1–2 weeks of the disease can decrease the chronic sequelae. The main development in the ophthalmologic treatment of SJS/TEN in the USA over the last 15 years has been the use of AMT on the ocular surface and eyelids during the acute phase. The evolution of AMT techniques, refinement of the evaluation of the eyes in acute SJS, and the efforts to increase the use of AMT in the USA are discussed.

Toxic epidermal necrolysis in adult patients: Experience from the West Australian Collaboration

“…More recently, a randomised controlled trial in 2016 found a significant benefit ( p = 0.042) at 6‐month follow‐up to the average best‐corrected visual acuity of the 25 eyes that received AMT and medical therapy over the 25 eyes that received medical therapy alone 29 . A 2021 review from the USA noted the growing literature supportive of early AMT in severe ocular SJS/TEN, particularly if carried out in the first week of disease 30 …”

“…29 A 2021 review from the USA noted the growing literature supportive of early AMT in severe ocular SJS/TEN, particularly if carried out in the first week of disease. 30 Anogenital care…”

Novel technique for amniotic membrane transplantation for acute Stevens-Johnson syndrome/toxic epidermal necrolysis patients

“…Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) can cause severe scarring of the ocular surface, dry eye and visual impairment [ 1 ]. The use of amniotic membranes (AM) in the acute phase of SJS/TEN can minimize the development of late complications [ 2 ].…”