Ocular complications in SJS and TEN may occur

acutely, together with or after the onset of skin involvement.

Severe ocular complications may even result in
permanent visual loss due to corneal scarring or vascularization.
There is currently a paucity of literature on the ocular manifestations of these diseases,
particularly longterm
ones. These have also mainly characterized ocular
complications in predominantly Caucasian populations.
Genetic differences in drug metabolism may turn up
differences in the severity of disease in East Asian
patients.
Acute ocular involvement was defined as previously described
elsewhere (5). Briefly, mild ocular involvement comprised lid edema
and/or mild conjunctival injection and/or chemosis only. Moderate
involvement comprised membranous conjunctivitis and/or corneal
epithelial defects, more than 30% healing with medical treatment
and/or corneal ulceration and/or corneal infiltrates. Severe
involvement comprised symblepharon formation and/or nonhealing
corneal epithelial defects and/or visual loss and/or conjunctival
fornix foreshortening.
Ocular
treatments included topical corticosteroids, antibiotics
(eye drops and ointment) and lubricants (preservativefree)
and were used in 58%, 74% and 86% of patients
respectively. Patients who had received topical corticosteroid
(P 0.031, Fishers exact test, 95% CI: 1.28
26.90) and who had received lubricants (P 0.003,
Fishers exact test, 95% CI: 2.54262.39) were more
likely to receive concurrent topical antibiotics.
The late ocular complications rates for patients
StevensJohnson syndrome, first reported in
1922,1 is an acute inflammatory disease that
predominantly affects skin and mucosal membranes
including the ocular surface. In the acute
phase, ocular manifestations include corneal
ulceration and severe pseudomembranous
conjunctivitis.25 After the initial attack has
passed, about half of the patients with severe
systemic StevensJohnson syndrome continue
to have ocular surface problems that include
symblepharon, entropion, ectropion, trichiasis,
dry eye, persistent conjunctival inflammation,
conjunctival injection, and corneal opacification.
45

It is t

Treatment consists of antibacterial and anti-inflammatory measures. Eyelid

hygiene, using either commercially available eyelid scrub kits or warm water with diluted
baby shampoo, may help reduce bacterial colonization and the accumulation of sebaceous
secretions. Patient education should emphasize treatment directed toward the base of the
lashes with a moistened cotton-tipped applicator or a small, soft facecloth sudsed with a
dilute concentration of baby shampoo. Fo ll OWing scrubs, a thin film of antibiotic ointment
may be applied to the eyelid margins. Topical bacitracin, erythromycin and azithromycin
are commonly used. In addition, aqueous tear defiCiency and/or lipid-induced tear-film
instability is freque ntly present, and the use of artificial tears or other dry-eye remedies
may be beneficial.
Cases with a prominent conjunctivitis component should be treated with an antibiotic
solution. Treatment for staphylococcal blepharitis is frequently prolonged and repeated.
This factors into the physician's selection of a topical antibiotic. To minimize toxicity
and resistance, a well-tolerated, relatively narrow, spectrum antimicrobial agent effective
against the majority of staphylococci should be selected. When possible, the agent should
be shown to be efficacious by susceptibil ity testing data from the local or regional microbiology
laboratory.
Anti-inflammatory therapy consists of lim ited and judiciOUS use of mild doses of top ical
corticosteroids in selected cases. Corticosteroids should be reserved for patients who
have a strong inflammatory component with little active infection. Patients with routine
staphylococcal blepharitis or blepharoconj unctivitis may obtain more rapid symptomatic
relief with the use of adjunctive topical corticosteroids, but the potential risks include prolonging
or worsening the infection or inducing corticoste roid-related side effects. Therefore,
corticosteroid use in routine cases is strongly discouraged.
Corticosteroids provide little therapeutic benefit for toxic-related punctate epithelial
keratopathy. In contrast, marginal infil trates and phlyctenulosis have a strong immunologic
component and can thus respond to topical cort icosteroid therapy. In the case
of phlyctenulosis. corticosteroids are usually necessary early in the course of treatment.
Conversely, in the case of marginal infiltrates, eyelid hygiene and antibiotic therapy alone
may be sufficient. If the therapeutic effect is inadequate after a few days (in the case of
marginal infiltrates), a time-limited cou rse of low-dose corticosteroid can be prescribed.

Dafpus

1.

2. Diagnosis and Treatment

of Stevens-
Johnson Syndrome and Toxic
Epidermal
Necrolysis with Ocular
Complications
Chie Sotozono, MD, PhD,1 Mayumi Ueta, MD, PhD,1 Noriko Koizumi, MD, PhD,1
Tsutomu Inatomi, MD, PhD,1 Yuji Shirakata, MD, PhD,2 Zenro Ikezawa, MD, PhD,3
1. Koji Hashimoto, MD, PhD,2 Shigeru Kinoshita, MD, PhD1

3. Monica. Sindrom Stevens-Johnson. Didapat dari: http://elib.fk.uwks.ac.id/.

4. Djuanda A. Sindrom Stevens-Johnson. Ilmu Penyakit Kulit dan Kelamin edisi 5. Bagian
Ilmu Penyakit Kulit dan Kelamin Fakultas Kedokteran Universitas Indonesia. Balai
Penerbit Fakultas Kedokteran Universitas Indonesia. Jakarta. 2007:163-5.
5.