STEVENS JOHNSON SYNDROME
WHAT IS STEVENS-JOHNSON SYNDROME?
Stevens-Johnson Syndrome (SJS) / toxic epidermal necrolysis (TEN) is a rare disorder of the skin and mucous membranes that occurs as a reaction to a medication or infection.
Once the medication is administered or the infection occurs, the body has an acute, severe reaction that results in flu-like symptoms, painful rash, blisters, and a shedding of the skin, which requires immediate hospitalization.
Toxic epidermal necrolysis is the classification of a severe form of Stevens-Johnson Syndrome, where 30% of the skin's surface is affected.
Because the eyes involve both skin and mucous membranes, they can be affected in patients with SJS/TEN. After the acute reaction, long term problems can occur such as dryness due to scarring of the lids, scarring on the cornea and conjunctiva, and symblepharon formation (adhesions between the lids and the eye).
HOW ARE EYE PROBLEMS FOR SJS/TEN TREATED?
Most of the eye problems associated with Stevens-Johnson Syndrome are a result of the dryness that occurs because of scarring of the lids and eye. The symblepharons (adhesions) between the lid and the eye can also make it difficult to open the eye.
Ocular symptoms of Stevens-Johnson Syndrome may include discomfort, dryness, light sensitivity, and vision that is blurry or fluctuates upon blinking.
There needs to be an effective dry eye treatment strategy. As our patient, you will come in for imaging and we will use different tools to monitor the health of the surface of the eye and track how our treatments are making progress.
Scleral lenses are also frequently used in Stevens-Johnson Syndrome patients and can improve the quality of the eye immensely.
HOW CAN SCLERAL LENSES HELP PEOPLE WITH STEVENS-JOHNSON SYNDROME?
Scleral lenses are a unique type of lens made of an oxygen-permeable rigid plastic that is filled with a sterile saline solution before being placed on the eye.
"Contact lens" is not-applicable to this type of lens because there is no contact with the lens and the cornea (clear front of the eye). This type of lens lands on the white portion of the eye, the sclera.
The space between the cornea and the lens is filled with saline, providing moisture to the cornea all day long. This is especially crucial in patients with Stevens-Johnson syndrome patients who have very compromised corneal surfaces and a lot of dryness.
This lens essentially vaults over all the scarring and irregularities from dryness on the cornea creates a new, more perfect, front surface of the eye. This way, light rays can reach the retina in a more uniform way, resulting in sharper vision.
Over time, many patients with scarring and neovascularization (growth of vessels) will see a clearing of the cornea as a result of the moisture protection of the scleral lens. This clearing results in better vision, the longer the lens is worn.