The Ophthalmologist's Role in the Management of Acute Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Abstract Stevens-Johnson syndrome (SJS) and its more severe variant, toxic epidermal necrolysis (TEN), are relatively rare but have high mortality rates. Survivors are frequently afflicted with severe blinding ocular surface diseases. Recent literature in the areas of ophthalmology and dermatology i...

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Bibliographic Details
Published in:The ocular surface 2010-10, Vol.8 (4), p.193-203
Main Authors: Fu, Yao, MD, PhD, Gregory, Darren G., MD, Sippel, Kimberly C., MD, Bouchard, Charles S., MD, Tseng, Scheffer C.G., MD, PhD
Format: Article
Language:English
Subjects:
acute management
Amnion - transplantation
amniotic membrane transplantation
Biological Dressings
Epithelium, Corneal - transplantation
erythema multiforme major
Glucocorticoids - administration & dosage
Humans
limbal stem cell deficiency
Ophthalmology
Physician's Role
Stem Cell Transplantation
steroids
Stevens-Johnson syndrome
Stevens-Johnson Syndrome - diagnosis
Stevens-Johnson Syndrome - therapy
toxic epidermal necrolysis
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Summary:Abstract Stevens-Johnson syndrome (SJS) and its more severe variant, toxic epidermal necrolysis (TEN), are relatively rare but have high mortality rates. Survivors are frequently afflicted with severe blinding ocular surface diseases. Recent literature in the areas of ophthalmology and dermatology illustrate that the ophthalmologist's role should no longer be considered secondary in the acute management of SJS/TEN. Accurately differentiating SJS or TEN from erythema multiforme majus (EMM) at the onset of the disease is important, because the management approach to these disease entities differs. Systemic cyclosporine and intravenous immunoglobulin have shown some potential as treatments for SJS/TEN, but their efficacies remain controversial. Amniotic membrane transplantation and intravenous corticosteroid pulse therapy at the acute stage have shown promise for preventing late sight-threatening cicatricial complications. An improved staging system for the ocular surface involvement of acute SJS/TEN, as well as better understanding of the underlying destructive pathogenic mechanism, should further improve our ability to predict ocular involvement and develop new therapeutics to abort destructive processes at the acute stage.
ISSN:1542-0124
1937-5913
DOI:10.1016/S1542-0124(12)70234-3