Ocular Findings and Management in a Steven-Johnson Syndrome Patient

Ocular Findings and Management in a Steven-Johnson Syndrome Patient Hania Kahlon1, Dr. Mark Jenkins, MD2 1University of North Texas Health Science Center, Fort Worth, TX, 2Houston Eye Associates at the Woodlands, TX, Background: Steven Johnson Syndrome (SJS) is a rare, severe mucocutaneous reaction that commonly occurs in response to medications. The response involves necrosis of the epidermis with severe effects on the patient’s mucous membranes. SJS occurs in two to seven people per million each year, with overall mortality at 30%. In our case, we focus on the ocular findings of SJS. Reported ocular findings of SJS commonly include photophobia, severe conjunctivitis, and corneal ulceration. We present a case of SJS to discuss ocular findings in SJS and emphasize the importance of proper recognition of the clinical indications and management of SJS. Case Information: We present the case of a 52 year old patient who was diagnosed with Steven Johnson Syndrome in January of 1984, 24 hours after taking a sulfa drug. Though the patient was initially misdiagnosed, the patient was eventually admitted with SJS for a 6-week inpatient stay. The patient was placed on a course of outpatient steroids after his hospital stay. It was not until April of 1985 that the patient began seeing an ophthalmologist for his deteriorating vision. The ophthalmologist found that the patient’s ocular findings included trichiasis without entropion of both left and right eyelids, corneal epithelial defect in both eyes, pinguecula of the conjunctiva of both eyes, and hyperemia with lid eversion in both eyes. The patient presents to the office every week for epilation of his lashes, as he has for over 20 years. We followed the patient for a period of 6 months to monitor for any changes in his ocular findings. The management of the patient’s ocular findings includes weekly epilation of his lashes, along with medications. Conclusion: This case highlights the ocular findings that can be found in the rare SJS patient. Furthermore, our case indicates the need for further research on the ocular management of SJS. Since our patient’s SJS was initially misdiagnosed, our case also indicates the importance of clinical knowledge of the early symptoms of SJS. We hope that, by sharing this information, we can add to the limited research and documentation that we currently have of this rare condition.