Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Mar 5:26:101473.
doi: 10.1016/j.ajoc.2022.101473. eCollection 2022 Jun.

Challenges in the management of bilateral eyelid closure in Stevens-Johnson Syndrome

Yulia Aziza  1 , Kohei Harada  1 , Mayumi Ueta  1 , Hideki Fukuoka  1 , Shigeru Kinoshita  2 , Chie Sotozono  1
Affiliations
Case Reports

Challenges in the management of bilateral eyelid closure in Stevens-Johnson Syndrome

Yulia Aziza et al. Am J Ophthalmol Case Rep. .

Abstract

Purpose: To describe the challenges of surgically treating Stevens-Johnson syndrome (SJS) cases with bilateral eyelid closure, a serious ocular sequela.

Observations: This study involved two 69-year-old females, with subacute-stage SJS (Case 1 and Case 2), and a 37-year-old male with chronic-stage SJS (Case 3). Case 1 had undergone simultaneous bilateral symblepharon lysis at 4-months post SJS onset, and her logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (VA) (BCVA) improved from 2.8 (both eyes) to 0.7 OD and 0.4 OS. Cases 2 and 3 underwent symblepharon lysis with intraoperative use of mitomycin C (MMC) and amniotic membrane transplantation (AMT) at 9 months (OD) and 11 months (OS) (Case 2) and at 31 years (OD) (Case 3) post SJS onset. At 3-months postoperative, Case 3 underwent cultivated oral mucosal epithelial sheet transplantation (COMET). In both cases, BCVA (logMAR) improved with the postoperative use of limbal-rigid contact lenses (CLs); i.e., from 2.8 to 0.5 OD and 1.2 OS (Case 2) and from 2.8 to 1.1 OD (Case 3). In all 5 treated eyes, eyelid opening and VA were maintained through final follow-up.

Conclusion and importance: In severe bilateral symblepharon cases, it can be difficult to predict postoperative outcomes, as proper surgical treatment is often delayed. In SJS cases with bilateral eyelid closure, the surgical intervention strategy of AMT and COMET, combined with limbal-rigid CL wear post surgery, can result in improved vision, and symblepharon surgery might be easier and possibly result in a better prognosis when performed at the early phase.

Keywords: Amniotic membrane transplantation (AMT); Cultivated oral mucosal epithelial sheet transplantation (COMET); Improvement of visual acuity; Severe symblepharon.

PubMed Disclaimer

Conflict of interest statement

The following authors have no financial disclosures: YA, KH, MU, HF, SK, CS.

Figures

Fig. 1
Fig. 1
The pre- and postoperative ophthalmological findings in Case 1. Images obtained at initial presentation showing the appearance of the patient's right eye (1a) and left eye (1b). The patient underwent bilateral symblepharon surgical release simultaneously due to the patient's social condition. An unexpected clear cornea with mild inflammation on the ocular surface was found in both eyes (1c, right eye; 1d, left eye). Schema illustrating the condition of each eye prior to surgery (1e).
Fig. 2
Fig. 2
The pre- and postoperative ophthalmological findings in Case 2. Images showing the appearance of the patient's right eye with an opened lower punctum (2a) and left eye (2b) prior to surgery. At 2.5-years postoperative, mild recurrence of symblepharon was observed in the right eye (2c). Successful symblepharon surgery resulted in maintaining a good postoperative outcome in the left eye with only mild cornea opacity (2d). Schema illustrating the condition of each eye prior to surgery (2e).
Fig. 3
Fig. 3
The pre- and postoperative ophthalmological findings in Case 3. Images showing total eyelid closure in the right eye (3a) and left eye (3b) prior to surgery. Right eye condition on the last follow-up (3c) and fitted with a limbal-rigid contact lens (Suncon Kyoto-CS®) to improve the visual acuity (VA) (3d). Schema illustrating the condition of the right eye prior to surgery (3e). Graph illustrating the change of right-eye VA from pre to post surgery, including the UCVA and BCVA after additional post-operative Suncon Kyoto-CS® lens wear (3f). UCVA: uncorrected visual acuity; BCVA: best corrected visual acuity; CS-lens: Suncon Kyoto-CS® limbal-rigid contact lens.
See this image and copyright information in PMC

References

    1. Harr T., French L.E. Toxic epidermal necrolysis and Stevens-Johnson syndrome. Orphanet J Rare Dis. 2010;5:39. - PMC - PubMed
    1. Schwartz R.A., McDonough P.H., Lee B.W. Toxic epidermal necrolysis: part I. introduction, history, classification, clinical features, systemic manifestations, etiology, and immunopathogenesis. J Am Acad Dermatol. 2013;69(2):173. e1-13;quiz 85-86. - PubMed
    1. Bastuji-Garin S., Rzany B., Stern R.S., Shear N.H., Naldi L., Roujeau J.-C. Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme. Arch Dermatol. 1993;129(1):92–96. - PubMed
    1. Jain R., Sharma N., Basu S., et al. Stevens-Johnson syndrome: the role of an ophthalmologist. Surv Ophthalmol. 2016;61(4):369–399. - PubMed
    1. Kohanim S., Palioura S., Saeed H.N., et al. Acute and chronic ophthalmic involvement in Stevens-Johnson syndrome/toxic epidermal necrolysis – comprehensive review and guide to therapy. II. Ophthalmic disease. Ocul Surf. 2016;14(20):168–188. - PubMed

Publication types

LinkOut - more resources