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Ocular manifestations in acute stage Stevens-Johnson syndrome/toxic epidermal necrolysis - A retrospective study in a tertiary hospital in south India

 Department of Ophthalmology, Ramaiah Medical College Hospital, Bengaluru, Karnataka, India

Correspondence Address:
Samyakta A Shetti,
Department of Ophthalmology, Ramaiah Medical College Hospital, MSR Nagar, MSRIT Post, Bengaluru - 54, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tjo.tjo_13_21

Purpose: To describe the ocular manifestations in the acute stage of Stevens-Johnson syndrome/ toxic epidermal necrolysis. Methods: We reviewed all the medical records of patients diagnosed with Stevens-Johnson syndrome/ toxic epidermal necrolysis and erythema multiforme between 2012 and 2019. Demographics, ophthalmic manifestations, and the treatment given systemically and locally were reviewed and analyzed. Results: We had forty-five patients admitted to our hospital between Jan 2012 to Dec 2019 with SJS/TEN as a diagnosis.Twenty-six (57.5%) of them were females, and 19(42.2%) were males. The mean age was 27.5 years.Forty (88.9%) of our cases were diagnosed as Stevens-Johnson syndrome, and five (11.9%) as toxic epidermal necrolysis.We found antiepileptics as a triggering agent in thirteen cases (28.8%).Fever (84.4%) and mucosal lesions (86.7%) were the most common presenting symptom.We found ocular symptoms in only 22 (48.9%) patients.The treating physicians referred only thirty-one cases to the ophthalmologist, out of which 22 cases were referred within three days of admission.The most common ocular involvement was conjunctival congestion (69%).Ocular grading showed that mild grade included 42.9%, moderate grade 28.6%, and severe grade 28.6% of the cases.The ocular treatment involved medical management with lubricating drops (100%), topical steroids (58.6%), and topical antibiotics (68.9%). Five individuals with a severe grade of ocular involvement underwent amniotic membrane transplantation. Conclusion: Ocular examination and grading are essential in the acute stage of SJS/TEN. It helps the ophthalmologist recognize the sentinel findings and institute appropriate treatment in the acute stage as early as possible.

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