Ocular manifestations and outcome of treatment of Stevens-Johnson Syndrome: experience at a Nigerian University Teaching Hospital

Abstract

Background: Stevens-Johnson Syndrome (SJS) is an immune-based reaction, usually to drugs, resulting in muco-cutaneous eruptions that lead to sores that heal with variable degrees of scarifications. Ocular surface and adnexal inflammation and cicatrisation occur, resulting in degrees of ocular motility, tear-function, and visual defects. Documentation of this disease is abundant in West Africa but reports on the management of the ocular complication deployed and their outcome are scarce.
Objective: The objective of this paper is to document our experience of the eye complications of this disease at a tertiary eye center in Nigeria, management deployed, and outcomes of the treatment.
Methodology: This is a retrospective study of seven patients with SJS who presented between 2006 and 2010 at Guinness Eye Center Onitsha evaluated by principal investigator (OMC) and other members of the team (ACC and EVU). Relevant data were extracted from clinical history, physical, ocular examinations and laboratory studies done, treatment administered, with the outcomes.
Results: Commonest precipitating factors were anti-malarial medications used in self-treatment, and bought as over the counter drugs. Full blood count, urinalysis and HIV tests were all normal. Management included medication in all and surgery in three.
Eventual adnexal and ocular surface cicatrisation depended on how early the patient presented to hospital. Final visual acuity depended on presenting visual acuity, how early in the disease patients presented, degree of inflammation and the degree of ocular surface cicatrisation.
Conclusion: Ocular involvement in SJS results in widely differing degrees of ocular disability. Management involves medications and surgery. Treatment of severe cicatrisation gave disappointing visual results.

Keywords: Cicatrisation, conjunctival congestion, medications, outcome, surgery