Ocular involvement in Stevens–Johnson syndrome and toxic epidermal necrolysis: A review of current management and changing trends

Abstract

Among the mucosal involvement in Stevens–Johnson syndrome (SJS), the eye is a significant component. Severe complications may result in vision impairment and, in extreme cases, the loss of the globe. Therefore, it is essential that ocular manifestations are effectively managed. The classification of ocular SJS/toxic epidermal necrolysis (TEN) in acute and chronic stages has evolved over time. In light of these developments, the management of the disease has also undergone significant improvements. Amniotic membrane transplantation (AMT) represents an efficacious approach to controlling acute inflammation, particularly in cases of severe or extreme severity. Practical methods, such as ProKera® or sutureless AMT, have been introduced. To successfully manage the chronic stage, it is of the utmost importance to correctly identify the underlying problem. In addition to various techniques such as minor salivary gland transplantation and punctal occlusion, the rehabilitative management of the ocular surface also encompasses the utilization of specially designed scleral lenses, namely Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE). Autologous mucosal membrane grafting, a technique that has been in use for many years, has recently seen a resurgence in popularity. In the context of limbal stem cell transplantation procedures, the introduction of cultured limbal epithelial transplantation and simple limbal epithelial transplantation represents a significant advancement. Although the success rate of keratoplasty and keratoprosthesis remains low, establishing good ocular surface homeostasis beforehand significantly improves the outcome.