Correlation of corneal complications with eyelid cicatricial pathologies in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis syndrome.
OBJECTIVE
To look at the correlation between many factors (time of hospitalization, floppy eyelid syndrome, trichiasis, open lacrimal puncta, symblepharon, and aqueous tear deficiency) and corneal complications in Stevens-Johnson syndrome (SJS).


METHODS
Observational cases series.


METHODS
Clinical data were retrospectively reviewed from 38 patients (32.7+/-20.1 years old) with SJS (n = 11) and with toxic epidermal necrolysis (TENS) (n = 27) from January 2002 to August 2004. One case report with SJS was included to verify the presence of tarsal/lid margin ulceration at the acute stage.


METHODS
The medical history was retrieved regarding presumed causative medications used within 15 days and the duration of hospitalization. Data of the latest photographic documentation and eye examination were compared and correlated in a masked fashion.


METHODS
Floppy eyelid, trichiasis, lid margin keratinization, meibomian gland orifice metaplasia, symblepharon, tarsal scar, and corneal complications.


RESULTS
Acute SJS/TENS was characterized by tarsal conjunctival ulceration. Keratinization of the eyelid margin with variable degrees of meibomian gland dysfunction was observed in all cases. Floppy eyelid, trichiasis, partially or totally opened lacrimal punctum, symblepharon, and aqueous tear deficiency were not significantly correlated with corneal complications. In contrast, there was a strong correlation between the severity of eyelid margin and tarsal pathology and the extent of corneal complications (Spearman r, 0.54; P = 0.0005). A multivariable regression analysis also showed that the extent of eyelid and tarsal pathology had a significant effect on corneal complications (coefficient, 0.84; P = 0.006).


CONCLUSIONS
Patients with acute SJS/TENS are characterized by severe inflammation and ulceration of the tarsal conjunctiva and lid margins. If left unattended, lid margin keratinization and tarsal scar, together with lipid tear deficiency, contribute to corneal complications because of blink-related microtrauma. Attempts to suppress inflammation and scarring by amniotic membrane transplantation at the acute stage and to prevent microtrauma at the chronic stage are vital to avoid sight-threatening complications.
Di Pascuale
Mario A
MA
Ocular Surface Center, Miami, Florida 33173, USA.
Espana
Edgar M
EM
Liu
Daniel Tzong-Shyue
DT
Kawakita
Tetsuya
T
Li
Wei
W
Gao
Ying Y
YY
Baradaran-Rafii
Alireza
A
Elizondo
Antonio
A
Raju
V-K
VK
Tseng
Scheffer C G
SC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000650:Amnion / Q000637:transplantation; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D003229:Conjunctival Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery; D003316:Corneal Diseases / Q000209:etiology* / Q000473:pathology; D005141:Eyelid Diseases / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000150:complications* / Q000601:surgery; D014456:Ulcer / Q000150:complications / Q000473:pathology / Q000601:surgery