Risk factors for the development of ocular complications of Stevens-Johnson syndrome and toxic epidermal necrolysis

Abstract

Objectives: To describe the acute and late ocular manifestations of toxic epidermal necrosis (TEN), Stevens-Johnson syndrome (SJS), and overlap syndrome and to identify predictors for the development of ocular complications.

Design: Retrospective cohort study.

Setting: A single referral unit in a university hospital.

Patients: The study included 159 patients (mean [SD] age, 49.9 [19.8] years) with TEN and SJS during an 8-year period. Forty-nine patients were contacted at least 15 months after hospital discharge.

Main outcome measures: Records were reviewed for demographics, cause of the condition, and severity of ocular involvement. The patients were contacted to assess late ocular complications.

Results: A total of 117 patients (74%) had acute ocular involvement, which was mild in 58%, moderate in 8%, and severe in 8%. Patients with TEN had more frequent (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.06-6.90; P = .05) but not more severe (OR, 0.95; 95% CI, 0.20-4.5; P = .99) acute ocular involvement. Forty-nine patients were contacted at least 15 months after hospital discharge, and 63% had late ocular complications. Dry eye syndrome was the most common. The mean (SD) Ocular Surface Disease Index score was 32.9 (30.3) (range, 0-97.5). The severity of the acute ocular disease was found to be the only significant risk factor of late complications (P = .002), even though 5 patients without acute ocular involvement developed dry eye syndrome.

Conclusions: Ocular involvement is common in patients with SJS and TEN. Late complications are more frequent in patients with severe initial eye involvement but may also develop in patients without patent initial ocular symptoms.