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C. Sotozono, M. Ueta, N. Koizumi, S. Hibino, T. Inatomi, S. Kinoshita; Acute Conjunctivitis as the Initial Symptom of Stevens-Johnson Syndrome With Ocular Complications and the Consequence of Topical Steroids. Invest. Ophthalmol. Vis. Sci. 2007;48(13):361.
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© ARVO (1962-2015); The Authors (2016-present)
To clarify the characteristics of Stevens-Johnson syndrome (SJS) with ocular complications, we analyzed the details of a clinical course of SJS at the acute stage and evaluated whether the use of topical steroids during the first week from the onset affects the visual prognosis.
We investigated the details of clinical manifestations at the disease onset by means of conducting structured interviews with 55 patients of SJS with chronic ocular complications from Nov 2005 to Sep 2006. The questionnaires were structured as follows; the existences and the order of high fever, conjunctivitis, skin eruptions and common cold-like symptoms, the diagnosis at disease onset, and causative drugs. We also inquired about the use of topical steroids during the first week from the onset and analyzed their effect on the visual outcomes.
Among 55 patients, 48 patients (87%) had a history of drug administration; cold remedies (18), antibiotics (11), NSAIDs (8), and others. Common cold-like symptoms (malaise, fever, sore throat, etc.) preceded skin eruptions in 44 patients. Very high fever was reported by 53 patients, and skin eruptions and acute conjunctivitis occurred in all patients. Thirty-nine patients remembered the order of their symptoms in detail, and 28 patients (72%) reported episodes of acute conjunctivitis 0.5-3 days prior to the skin eruptions. Nine patients were diagnosed with acute conjunctivitis by ophthalmologists, thereafter systemic eruptions developed. In 10 patients, eruptions and conjunctivitis occurred simultaneously. While 17 patients started topical steroid use during the first week from the onset, 21 patients received no treatment for the eye. Visual prognosis was significantly better in the group receiving topical steroids at the acute stage (P<0.00001).
SJS with ocular complications is accompanied by acute conjunctivitis as an initial symptom. Administration of topical steroids during the first week following disease onset greatly improves the visual prognosis.
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