Original articleNew Grading System and Treatment Guidelines for the Acute Ocular Manifestations of Stevens-Johnson Syndrome
Section snippets
Study Population
Photographs and clinical records of 158 eyes of 79 consecutive patients diagnosed with SJS or TEN were reviewed after approval by the Colorado Multiple Institutional Review Board. All patients were treated at the University of Colorado Hospital or the Children's Hospital of Colorado between June 2006 and July 2013. The extent and location of epithelial sloughing, as determined by fluorescein staining, was documented in each case. The treatments received were noted, and the visual outcomes and
Results
Results are summarized in Table 2.
Discussion
Because of the rarity of SJS and TEN, most ophthalmologists do not treat acute-phase patients on a regular basis. Given the potentially devastating visual problems, however, it is imperative that all ophthalmologists be aware of the current methods for the evaluation and treatment of the disease. The previous lack of clear criteria for the assessment of the acute eye findings has made clinical decision making difficult and has prevented a cohesive method for evaluating and treating these
References (19)
- et al.
Amniotic membrane in the surgical management of acute toxic epidermal necrolysis
Ophthalmology
(2002) - et al.
Amniotic membrane transplantation in acute phase of toxic epidermal necrolysis with severe corneal involvement
Ophthalmology
(2006) - et al.
Amniotic membrane grafting for conjunctival and lid surface disease in the acute phase of toxic epidermal necrolysis
J AAPOS
(2007) - et al.
Amniotic membrane transplantation as a new therapy for the acute ocular manifestations of Stevens-Johnson syndrome and toxic epidermal necrolysis
Surv Ophthalmol
(2009) Treatment of acute Stevens-Johnson syndrome and toxic epidermal necrolysis using amniotic membrane: a review of 10 consecutive cases
Ophthalmology
(2011)- et al.
Successful treatment of acute ocular involvement in Stevens-Johnson syndrome with amniotic membrane transplantation: a case report
Can J Ophthalmol
(2012) - et al.
Toxic epidermal necrolysis in a 15-month-old girl successfully treated with amniotic membrane transplantation
J AAPOS
(2012) - et al.
Adjuvant role of amniotic membrane transplantation in acute ocular Stevens-Johnson syndrome
Ophthalmology
(2016) - et al.
Analysis of the acute ophthalmic manifestations of the erythema multiforme/Stevens-Johnson syndrome/toxic epidermal necrolysis disease spectrum
Ophthalmology
(1995)
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Vulvovaginal and ocular involvement and treatment in female patients with Stevens–Johnson syndrome and toxic epidermal necrolysis: A review
2021, International Journal of Women's DermatologyCitation Excerpt :Persistence of epithelial defects poses a risk for infection and scarring (Gregory, 2016). Treatment is advanced based on disease severity, as outlined in Table 3 (Gregory, 2016; Power et al., 1995; Thorel et al., 2020). Medical treatment of acute ocular involvement in SJS /TEN is directed toward aggressively reducing inflammation with systemic immunosuppression and/or topical steroid therapy depending on the severity of the disease.
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Financial Disclosure(s):
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Author Contributions:
Conception and design: Gregory
Analysis and interpretation: Gregory
Data collection: Gregory
Obtained funding: none
Overall responsibility: Gregory