Stevens-Johnson syndrome (SJS), and its more severe variant,
toxic epidermal necrolysis (TEN), are life-threatening diseases of the skin and mucous membranes. After the acute-stage damage subsides, serious
visual impairment and severe
dry eye remains as ocular sequelae. At the acute stage, ocular complications occur in 77% of SJS/TEN patients. In cases with pseudomembranous formation and/or epithelial defects, the risk of ocular sequelae increases. Among 13
slit-lamp microscopy images that we obtained of SJS/TEN patients at the chronic stage, the loss of corneal epithelial stem cells and severe meibomian gland involvement were found to be the most common disorders. Severe
dry eye in SJS includes three important mechanisms: (1) aqueous tear deficiency, (2) decreased wettability of corneal surface, and (3) increased evaporation.
Dry eye severity in SJS patients is often underestimated when the meniscus is first observed, as the punctum is closed due to
scarring or surgery. In SJS patients with severe
dry eye, the dryness results in immense
eye pain, and unstable tear film related to
dry eye result in a change/loss of vision. For the treatment of
dry eye in SJS, it is important to suppress chronic
inflammation on the ocular surface, and 2%
rebamipide ophthalmic solution reportedly helps to obtain ocular surface stabilization. Scleral
contact lenses, as well as the newly developed limbal-rigid
contact lenses, improve the patients' visual acuity and reduce symptoms related to severe
dry eye. Further studies and new therapeutic methods are needed to more effectively treat
dry eye in patients afflicted with SJS/TEN.