Clinicians already know Stevens-Johnson syndrome—a rare but serious skin disorder—can have deleterious effects on the ocular surface in many ways, including limbal stem cell deficiency and, more recently, an increased risk of microbial keratitis.1,2 New data sheds more light on its association with dry eye, lid margin abnormalities and obstructive meibomian gland dysfunction with meibomian gland loss.3

The investigation, published in Cornea, reported that clinicians should look for the following combination of symptoms when making a diagnosis: meibomian gland dropout, tarsal conjunctival scarring, irregular Marx line and keratinization of the posterior eyelid margin.3

This single-center, prospective, non-controlled observational study enrolled 32 Thai patients (64 eyes) who had Stevens-Johnson for at least one year. All participants underwent a comprehensive ophthalmic exam including slit-lamp biomicroscopy, tear meniscus height, fluorescein tear break-up time, ocular surface fluorescein staining, eyelid morphology, Schirmer testing, meibomian gland expression and upper and lower lid meibography using a non-contact infrared meibograph.3

The study found 90.6% had a history of severe ocular complications in the acute stage of the disease. Additionally, medications were found to be the most common cause of Stevens-Johnson syndrome (93.8%). Researchers noted meibum quality could not be assessed in 71.9% of patients because the glands could not be expressed. The study found partial or complete loss of the meibomian glands in either the upper or lower eyelid in all patients.3

Investigators observed the degree of meibomian gland dropout was significantly correlated with tear break-up time, meibum quality and expressibility, ocular surface staining and the presence of long-term ocular sequelae, including symblepharon and limbal stem cell deficiency.3

1. Shortt A, Bunce C, Levis H, et al. Three-year outcomes of cultured limbal epithelial allografts in aniridia and Stevens-Johnson syndrome evaluated using the Clinical Outcome Assessment in Surgical Trials assessment tool. Stem Cells Transl Med. 2014 Feb;3(2):265-75.

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].

3. Lekhanont K, Jongkhajornpong P, Sontichai V, et al. Evaluating dry eye and meibomian gland dysfunction with meibography in patients with Stevens–Johnson syndrome. Cornea. June 12, 2019. [Epub ahead of print].