Relentless Ocular Breakdown In Stevens-Johnson Syndrome: A Case Of Progressive Surface Failure

Stevens-Johnson Syndrome (SJS) is a severe mucocutaneous disorder with sight-threatening ocular complications. This case highlights progressive ocular surface failure despite aggressive intervention. A 60-year-old female developed SJS after trimethoprim use, presenting with conjunctival inflammation, epithelial defects, and corneal ulceration. Despite treatment with amniotic membrane grafting (AMG), serum eye drops, and bandage contact lenses, she developed persistent epithelial breakdown and corneal perforation. Multiple surgical interventions, including tarsorrhaphy and penetrating keratoplasty, were required. This case underscores the need for early, sustained intervention to prevent irreversible vision loss.

This case was managed at a tertiary ophthalmology center with a multidisciplinary team, including ophthalmology, dermatology, and intensive care. The patient required multiple hospital admissions for corneal transplantation and lid surgeries. Despite aggressive treatment, progressive surface failure remained a challenge. This case highlights the need for early intervention and long-term follow-up to optimize outcomes in severe SJS cases.

A 60-year-old female developed SJS following trimethoprim use for a urinary tract infection. She presented with photophobia, conjunctival ulceration, and corneal defects, leading to visual loss. Early intervention included AMG, lubricants, antibiotics, and corticosteroids. Despite initial improvement, persistent epithelial defects required repeat AMG, bandage contact lenses, and serum eye drops.

Her condition worsened with corneal thinning, perforations, and lid margin keratinization, necessitating corneal gluing, tarsorrhaphy, and penetrating keratoplasty. Postoperatively, she developed fungal keratitis requiring antifungal therapy. Chronic inflammation led to corneal vascularization, lipid keratopathy, and progressive ocular deterioration.

Despite aggressive treatment, vision remained limited to hand movements. Long-term management included punctal occlusion, frequent epilation, and intensive lubrication. This case highlights the chronic nature of SJS-related ocular disease and the limitations of current therapies.

SJS can cause relentless ocular complications, with progressive corneal breakdown despite aggressive treatment. Early intervention, including AMG and inflammation control, is crucial, but long-term complications often necessitate repeated surgeries. Even with optimal care, vision loss remains a major risk. This case underscores the need for improved therapeutic strategies to prevent blindness and highlights the challenges of managing chronic ocular surface failure in SJS.