Stevens–Johnson syndrome (SJS) is a rare but serious skin disorder that can affect the eyes. Patients with ocular involvement may develop an acute, bilateral, mucopurulent conjunctivitis. Those severely affected develop chemosis, vesicles, bullae, pseudomembranes and corneal ulcerations.1

SJS’s cause remains unknown, but, according to a new report, it’s often paired with infective keratitis. An Indian research team sought to evaluate the microbiological profile and outcome in cases of infective keratitis in SJS. In instances when both SJS and microbial keratitis are present, surgical intervention is often required. However, the researchers explain, the antibiotic sensitivity pattern suggests that resistance is not that high.2

The investigators observed 200 SJS patients and found 34% (83 eyes of 68 patients) developed microbial keratitis over a period of five years. Corneal ulceration was centrally located in 62.6% of eyes, paracentral in 20.5% and peripheral in 16.8%. Approximately 62.5% of culture-positive eyes had bacterial infection, 80% of which were caused by Gram-positive bacteria. Researchers noted polymicrobial infection in 29.1%. Of the eyes studied, 68.6% healed with medical therapy, and 31.3% had corneal perforations that were later managed with cyanoacrylate glue application or therapeutic keratoplasty.

Systemic infection as an inciting factor of SJS and an early presentation for keratitis were the major risk factors associated with corneal perforation, according to investigators.2

1. Gurwood A. Is this an antibiotic reaction? Rev Optom. 2007;144(6):106.

2. Sharma N, Venugopal R, Singhal D, et al. Microbial keratitis in Stevens–Johnson syndrome a prospective study. Cornea. April 16, 2019. [Epub ahead of print].