scholarly journals USA: Ophthalmologic Evaluation and Management of Acute Stevens-Johnson Syndrome

2021 ◽  
Vol 8 ◽  
Author(s):  
Darren G. Gregory
Keyword(s):  
Acute Phase ◽  
Ocular Surface ◽  
Vision Loss ◽  
Stevens Johnson Syndrome ◽  
Amniotic Membrane Transplantation ◽  
Johnson Syndrome ◽  
Significant Damage ◽  
Main Development ◽  
The Usa ◽  
Chronic Sequelae

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) can cause significant damage to the ocular surface and eyelids. The sloughing and inflammation of the ocular mucosal epithelium during the acute phase may lead to scarring sequelae of the eyelids and ocular surface, resulting in pain and vision loss. Amniotic membrane transplantation (AMT) to the eyes and eyelids during the initial 1–2 weeks of the disease can decrease the chronic sequelae. The main development in the ophthalmologic treatment of SJS/TEN in the USA over the last 15 years has been the use of AMT on the ocular surface and eyelids during the acute phase. The evolution of AMT techniques, refinement of the evaluation of the eyes in acute SJS, and the efforts to increase the use of AMT in the USA are discussed.

scholarly journals Management of ocular involvement in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis: french national audit of practices, literature review, and consensus agreement

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
D. Thorel ◽  
S. Ingen-Housz-Oro ◽  
G. Royer ◽  
A. Delcampe ◽  
N. Bellon ◽  
...  
Keyword(s):  
Corticosteroid Therapy ◽  
Acute Phase ◽  
Amniotic Membrane ◽  
Systemic Corticosteroid ◽  
Stevens Johnson Syndrome ◽  
Amniotic Membrane Transplantation ◽  
Ocular Involvement ◽  
Eye Drops ◽  
Johnson Syndrome ◽  
Systemic Corticosteroid Therapy

Abstract Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) can lead to severe ophthalmologic sequelae. The main risk factor is the severity of the initial ocular involvement. There are no recommendations for ocular management during acute phase. We conducted a national audit of current practice in the 11 sites of the French reference center for toxic bullous dermatoses and a review of the literature to establish therapeutic consensus guidelines. We sent a questionnaire on ocular management practices in SJS/ TEN during acute phase to ophthalmologists and dermatologists. The survey focused on ophthalmologist opinion, pseudomembrane removal, topical ocular treatment (i.e. corticosteroids, antibiotics, antiseptics, artificial tear eye drops, vitamin A ointment application), amniotic membrane transplantation, symblepharon ring use, and systemic corticosteroid therapy for ophthalmologic indication. Nine of 11 centers responded. All requested prompt ophthalmologist consultation. The majority performed pseudomembrane removal, used artificial tears, and vitamin A ointment (8/9, 90%). Combined antibiotic-corticosteroid or corticosteroid eye drops were used in 6 centers (67%), antibiotics alone and antiseptics in 3 centers (33%). Symblepharon ring was used in 5 centers (55%) if necessary. Amniotic membrane transplantation was never performed systematically and only according to the clinical course. Systemic corticosteroid therapy was occasionally used (3/9, 33%) and discussed on a case-by-case basis. The literature about ocular management practice in SJS/ TEN during acute phase is relatively poor. The role of specific treatments such as local or systemic corticosteroid therapy is not consensual. The use of preservatives, often present in eye drops and deleterious to the ocular surface, is to be restricted. Early amniotic membrane transplantation seems to be promising.

scholarly journals Acute and Chronic Management of Ocular Disease in Stevens Johnson Syndrome/Toxic Epidermal Necrolysis in the USA

2021 ◽  
Vol 8 ◽  
Author(s):  
Derek Metcalfe ◽  
Omer Iqbal ◽  
James Chodosh ◽  
Charles S. Bouchard ◽  
Hajirah N. Saeed
Keyword(s):  
Chronic Disease ◽  
Toxic Epidermal Necrolysis ◽  
Acute Treatment ◽  
Management Strategies ◽  
Ocular Disease ◽  
Stevens Johnson Syndrome ◽  
Amniotic Membrane Transplantation ◽  
Ocular Involvement ◽  
Johnson Syndrome ◽  
The Usa

Stevens Johnson syndrome and toxic epidermal necrolysis are on a spectrum of a severe, immune-mediated, mucocutaneous disease. Ocular involvement occurs in the vast majority of cases and severe involvement can lead to corneal blindness. Treatment in the acute phase is imperative in mitigating the severity of chronic disease. Advances in acute treatment such as amniotic membrane transplantation have shown to significantly reduce the severity of chronic disease. However, AMT is not a panacea and severe chronic ocular disease can and does still occur even with aggressive acute treatment. Management of chronic disease is equally critical as timely intervention can prevent worsening of disease and preserve vision. This mini-review describes the acute and chronic findings in SJS/TEN and discusses medical and surgical management strategies.

scholarly journals Amniotic membrane transplantation (AMT) without the use of sutures/fibrin glue

2016 ◽  
Vol 7 (2) ◽  
pp. 173-177 ◽  
Author(s):  
Ajai Agrawal ◽  
V B Pratap
Keyword(s):  
Fibrin Glue ◽  
Dry Eye ◽  
Amniotic Membrane ◽  
Ocular Surface ◽  
Symptomatic Relief ◽  
Stevens Johnson Syndrome ◽  
Amniotic Membrane Transplantation ◽  
Sutureless Technique ◽  
Ocular Surface Reconstruction ◽  
Johnson Syndrome

Introduction: Amniotic membrane transplantation (AMT) has been used for a wide variety of ocular surface problems. Current techniques for the AMT involve suturing of the graft or patch over the ocular surface or use of fibrin glue.Objective: To describe a new sutureless technique of amniotic membrane transplantation (AMT) without the use of sutures/fibrin glue.Materials and methods: Amniotic membrane transplantation as overlay or patch was done in fourteen eyes of eight patients with severe dry eye due to Stevens Johnson syndrome for ocular surface reconstruction, promotion of epithelization, reduction of inflammation and symptomatic relief from dry eye. In this new technique of amniotic membrane transplantation, we mount the amniotic membrane with its epithelial side up on a conformer & place it on the ocular surface without applying any sutures.Conclusion: In all the fourteen eyes of eight patients operated at our centre, the amniotic membrane take up was satisfactory, with significant reduction of inflammation and symptomatic relief from dry eye. This is a simple, fast effective technique with surgical outcomes comparable to amniotic membrane transplantation using sutures/ fibrin glue.

Long-term Progression of Ocular Surface Disease in Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

Cornea ◽  
2020 ◽  
Vol 39 (6) ◽  
pp. 745-753
Author(s):  
Yamato Yoshikawa ◽  
Mayumi Ueta ◽  
Hideki Fukuoka ◽  
Tsutomu Inatomi ◽  
Isao Yokota ◽  
...  
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Ocular Surface ◽  
Ocular Surface Disease ◽  
Stevens Johnson Syndrome ◽  
Johnson Syndrome

scholarly journals Autologous Blood Products: When, Where, and How?

2021 ◽  
Vol 8 (1) ◽  
pp. 1-9
Author(s):  
Alfonso L Sabater ◽  
Keyword(s):  
Ocular Surface ◽  
Keratoconjunctivitis Sicca ◽  
Therapeutic Option ◽  
Autologous Blood ◽  
Stevens Johnson Syndrome ◽  
Eye Drops ◽  
Corneal Epithelial ◽  
Johnson Syndrome ◽  
Ocular Surface Diseases ◽  
Persistent Epithelial Defects

Autologous blood eye drops have become an interesting, well-known, and widely used therapeutic option for many ocular surface diseases since their introduction into the ophthalmologic field forty-six years ago. The foundation for their use in the treatment of pathologies such as severe keratoconjunctivitis sicca, persistent epithelial defects, ocular chemical burns, recurrent epithelial erosions, Stevens-Johnson syndrome, ocular graft versus host disease, and, lately, in many other ocular surface conditions, relies on the fact that they contain proteins, vitamins, cytokines, and growth factors that participate in the signaling pathways of corneal epithelial healing in similar amounts to those found in normal, healthy tear films

scholarly journals Multidisciplinary care in Stevens-Johnson syndrome

2020 ◽  
Vol 11 ◽  
pp. 204062231989446 ◽  
Author(s):  
Swapna S. Shanbhag ◽  
James Chodosh ◽  
Cherie Fathy ◽  
Jeremy Goverman ◽  
Caroline Mitchell ◽  
...  
Keyword(s):  
Supportive Care ◽  
Toxic Epidermal Necrolysis ◽  
Oral Mucosa ◽  
Acute Phase ◽  
Multidisciplinary Care ◽  
Stevens Johnson Syndrome ◽  
Chronic Complications ◽  
Optimal Care ◽  
Johnson Syndrome ◽  
Organ Systems

Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are potentially fatal mucocutaneous diseases that can involve many organ systems. Manifestations of SJS/TEN outside of the skin, eyes, and oral mucosa are not well defined or well recognized, and, therefore, are often not addressed clinically. As supportive care improves and mortality from SJS/TEN decreases, chronic complications in affected organ systems are becoming more prevalent. Recognition of the manifestations of SJS/TEN in the acute phase is critical to optimal care. In this review, we review the organ systems that may be involved in SJS/TEN, provide an overview of their management, and propose a list of items that should be communicated to the patient and family upon discharge. The organ systems discussed include the pulmonary, gastrointestinal/hepatic, oral, otorhinolaryngologic, gynecologic, genitourinary, and renal systems. In addition, the significant psychosocial, nutritional, and pain consequences and management of SJS/TEN are discussed.

scholarly journals Keratoconjunctivitis associated with nevirapine toxicity in HIV pregnant woman

2012 ◽  
Vol 2 (1) ◽  
pp. 6
Author(s):  
Bety Yañez
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Stevens Johnson Syndrome ◽  
Amniotic Membrane Transplantation ◽  
Eye Drops ◽  
Highly Active ◽  
Johnson Syndrome ◽  
Immunodeficiency Virus ◽  
Acquired Immunodeficiency ◽  
The Right ◽  
Immunodeficiency Syndrome

Highly active antiretroviral therapy (HAART) is the treatment of choice for human immunodeficiency virus-acquired immunodeficiency syndrome (HIV-AIDS) patients. Severe side effects of these drugs have been described that produce generalized autoimmune blistering diseases, such as Stevens-Johnson syndrome and toxic epidermal necrosis (TEN). These complications may seriously compromise the patient’s life or cause disabling consequences such as blindness. We describe a case of 21-year old female HIV patient with a CD4 count of 126 cells/microliter. Ten days post elective caesarean delivery she restarted HAART with nevirapine and developed TEN after approximately two weeks. Nevirapine was discontinued, but despite this, ocular surface disorder persisted. She presented severe bilateral keratoconjunctivitis that was treated with free tear substitutes, moxifloxacyn, and prednisolone acethate eye drops. At 2-month follow up her visual acuity without correction was 20/160 in the right eye and 20/40 in the left. She had bilateral moderate cicatricial keratoconjunctivitis and a central corneal leukoma in the right eye. Early treatment is important and should consist of preservative-free lubricants, and amniotic membrane transplantation to decrease the frequency of severe sequelae such as keratitis and corneal leukomas that will reduce the quality of life for these patients.

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