Stevens-Johnson Syndrome and Dry Eye

Stevens-Johnson Syndrome and Dry Eye

Article written by Paulus Maciel. Rights reserved.

One day, I published an article written by Carl Zeiss Vision on medications that can impair vision. This story had so much attention it received the message from a friend, Olaf Galvão, me suggesting an informative matter about the damage to the vision that the Stevens-Johnson syndrome (SJS) can cause and its relation to the use of certain medications. much I interested in the subject, because each in its award, are professional vision and all information that can educate people is and will always be welcome.

"The Stevens-Johnson syndrome, also called erythema multiforme major, part of a set of changes to skin and mucosal hypersensitivity reaction triggered by ... after use of certain drugs (eg, sulfonamides, anti-inflammatory, penicillin, barbiturates, allopurinol and vaccines) "
(1)

The Stevens-Johnson syndrome is considered rare, from 0.4 to 1.2 cases per 1 million persons per year
 (2) and currently there is a list of over 100 drugs that prolonged use can trigger the syndrome. Each year many experts, from dentists, urologists, dermatologists and ophthalmologists also present papers on their studies related to the treatment of SJS.

With respect to the eye, Stevens-Johnson acts on the conjunctiva, which is the acute catarrhal conjunctivitis (swelling and redness of the eyes) or mucopurulent (infectious)
 (3).

"After the acute arise conjunctival scarring and dry eye. Severe cases, changes may occur eyelid (...) and even corneal keratinization, compromising visual acuity"
 (4)

Throughout these paintings, patients perceive typical symptoms such as photophobia, ocular pain, discharge, tearing, irritation and foreign body sensation. These symptoms are very similar to conjunctivitis, but some tests such as Schirmer can detect severe dry eye, ocular consequence role in Stevens-Johnson syndrome.

A clinical study of the School of Medicine and published in the Brazilian Archives of Ophthalmology (1) in 2010 was performed in 7 patients with SJS with ocular symptoms previously detected. In attempt to reduce irritation and photophobia, in addition to keeping the eyes lubricated for longer, providing greater welfare to those who suffer from dry eye, were adapted scleral contact lenses in these patients. 

The scleral contact lens (contact lens that covers the entire cornea) is produced with diameters ranging form customized according to the characteristics of surfaces and each ocular of the sight and adjusted by hand by a prosthesis.

In this case series of patients with ocular sequelae of Stevens-Johnson syndrome, was highlighted in a clinical study, Escola Paulista de Medicina the high percentage of successful adaptation of scleral contact lenses, with improvement in symptoms of eye irritation, discharge and photophobia in 85% of cases.

 At the end of this matter, came to the conclusion that the eminence of prolonged use of medications such as anti-inflammatory, antimicrobial, etc., ask your doctor about the consequences of using these drugs long-term. Also ask your doctor if there are medicines for the same treatment, but without damage to future health.

References:

(1) - Contact lens scleral eye on rehabilitation of patients with Stevens-Johnson syndrome.Architect Bras. Oftalmol. vol.73 no.5 Sao Paulo Sept. / Oct. 2010.

(2) - Stevens-Johnson syndrome associated with the use of antimicrobials. University of Pernambuco. 2008.

(3) - Dantas PE. Cicatricial conjunctivitis. External ocular diseases and cornea. Rio de Janeiro: Culture Medica; 1999. p.226-32.

(4) - Gould HL. Therapeutic effect of flush fitting scleral lenses and hydrogel bandage lenses. Int Surg. 1973, 58 (7) :469-72.