PMC3674754_01
Patient with acute Stevens-Johnson syndrome, at the time of initial presentation to hospital and before initiation of treatment, showing conjunctival injection in both eyes.
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A 70-year-old woman, who had recently been started on allopurinol for gout, presented with a one-day history of bilateral eye pain, moderate conjunctival injection (Figure 1), and oral mucosal sloughing.
Patient's ophthalmic appearance at 2.5 days (60 hours) after disease onset. (A) The right eye demonstrates evidence of marked conjunctival injection. The right eye also shows defects in the bulbar conjunctival epithelium and epithelial sloughing of the eyelid margin. (B) The left eye shows similarly severe ophthalmic involvement.
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Her ophthalmic situation also progressed, with evidence of increased conjunctival injection, new bulbar conjunctival epithelial defects, and sloughing of the eyelid margin epithelium (Figure 2A and B).
Right lower fornix of the patient five weeks after disease onset. Evident is a contracted tarsal conjunctival membrane (arrow) resulting in cicatricial entropion, trichiasis, and corneal epithelial breakdown.
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The right eye exhibited a right lower lid cicatricial entropion with associated palpebral conjunctival cicatrix (Figure 3), trichiasis, and breakdown of the corneal epithelium.
Patient showing a significant difference in clinical appearance of the right and left eyes four months after disease onset. (A) The right eye demonstrates a cicatricial entropion with associated trichiasis and conjunctival injection. A fluid-filled scleral lens (PROSE device) is in place. (B) The left eye demonstrates normal upper and lower eyelid positions without evidence of trichiasis. A PROSE device is also visible.. Abbreviation: PROSE, Prosthetic replacement of the Ocular Surface Ecosystem.
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The eye ultimately required fitting with a Prosthetic Replacement of the Ocular Surface Ecosystem device (Boston Foundation for Sight, Needham, MA, USA), a fluid-filled scleral lens, in order to afford protection of the cornea from lid-induced and lash-induced mechanical trauma (Figure 4A). In contrast, the left eye revealed normal upper and lower eyelid positions, no trichiasis, and an intact corneal epithelium (Figure 4B).