Current Trends in the Management of Stevens–Johnson Syndrome: A Call for a Paradigm Shift in Ophthalmic Care in Nigeria

Abstract

Stevens–Johnson syndrome (SJS) is a severe blistering mucocutaneous  disorder, which affects the skin and at least two mucous membranes that very often includes the eyes. The ophthalmic complications, though  considered the most devastating of all the complications of the disease in survivors, are often a time the last to be attended to, with consequent life-changing sequelae. Medical therapy has been the mainstay of ophthalmic care in our locality, and these have not been shown to improve the long-term outcome of the disease. Glass rod synechiolysis, previously practiced in some centers, has been largely abandoned. Appropriate proactive  interventions such as lubrication, topical antibiotics, and steroids are  advocated in the acute phase. Surgical management to remove the  membranes and the use of improvised symblepharon rings prevent  adhesions. Amniotic membrane grafting or mucous membrane grafting for lid margin keratinization and forniceal scarring if implemented will also take advantage of a window of opportunity to ameliorate the severity of the  long-term sequelae requiring more specialized and expensive interventions for vision restoration. The critical role of the ophthalmologist in the  management of patients with SJS for the prevention of corneal blindness, therefore, cannot be overemphasized.

Keywords: Mucocutaneous disorder, Stevens–Johnson syndrome, toxic epidermal necrolysis