contact lens case reports

Managing Complications of Stevens Johnson Syndrome

contact lens case reports
Managing Complications of Stevens Johnson Syndrome

Figure 1. Photokeratoscopy of ocular surface with irregular astigmatism.

Stevens Johnson Syndrome (SJS) is a rare condition that occurs most commonly in young or middle-aged adults. Its onset is usually sudden with fever, malaise, sore throat and respiratory symptoms. Next, skin lesions of alternating red and white rings and bullae appear on the hands, feet, arms, legs, trunk and face. These erosive lesions may affect the mucus membranes, especially of the eyes, mouth and genitalia.

The ocular manifestations of SJS vary markedly and include severe keratoconjunctivitis sicca, total conjunctival and corneal scarring, keratinization of all ocular membranes and lid margins, corneal vascularization, entropion, trichiasis, symblepharon, perforation and blindness. The ocular course is difficult to predict at disease onset, but often the most serious long-term sequelae are the ocular complications.

Figure 2. Photokeratoscopy over the surface of the contact lens.

Getting the Facts

Patient WW is a 45-year-old male who was diagnosed with SJS at age 12 after systemic use of a sulfonamide. His left eye was enucleated in December 1999 secondary to a myriad of complications following multiple corneal transplants. He presented to our practice with visual acuity of 20/80 OD. External exam revealed extensive corneal neovascularization and scarring. The conjunctiva was keratinized with moderate symblepharon formation in the lower fornix. Additionally, there was significant entropion present with trichisis.

WW's ocular therapy included lid hygiene b.i.d., frequent (q. 30 minutes) non-preserved artificial tears, nightly bland ointment and rimexolone (Vexol, Alcon) p.r.n. for recurrent ocular surface inflammation.

Figure 3. The 15mm Jupiter lens on the patient's right eye.

Managing WW's Condition

Because of ongoing complications associated with the lids and lashes, we decided that the patient might benefit from a high-Dk scleral or semi-scleral lens. We subsequently fit the patient with Correctech, Inc.'s semi-scleral Jupiter Lens. The final lens parameters were 8.03mm base curve, ­6.00D power and 15mm diameter with a best corrected VA of 20/60 (Figures 1, 2 and 3).

These large diameter, high-Dk lenses provide many benefits to patients who have severe ocular surface disease, including improved visual correction, ocular surface protection from scarred lid margins, entropion and trichisis, ongoing lysis of symblepharon to maintain the conjunctival fornices and ocular surface protection from the debilitating effects of tear evaporation

Patrick Caroline is an associate professor of optometry at Pacific University and is an assistant professor of ophthalmology at the Oregon Health Sciences University. Mark André is director of contact lens services at the Oregon Health Sciences University and serves as an adjunct assistant professor of optometry at Pacific University.