A Novel Surgical Approach to Fornix Reconstruction in Stevens Johnson Syndrome

Abstract

Abstract: : Purpose:An uncommon complication of Stevens–Johnson syndrome is orbital inclusion cysts. In the setting of inferior fornix loss and anterior orbital cystic masses, we describe fornix reconstruction with cyst marsupialization. Methods:Interventional case report. Results:A previously healthy 17–year–old male developed tetracycline induced Stevens–Johnson syndrome resulting in extensive conjunctival synechiae with inferior fornix obliteration and restricted ocular motility. Additionally progressively enlarging bilateral inferior anterior orbital masses developed. The remainder of the ophthalmic examination was unremarkable including visual acuities of 20/20 OU. The masses and fornix were managed similarly in both eyes as follows. Initially, all synechiae were lysed and a horizontal conjunctival incision was made at the base of the remaining inferior fornix. Multiple cysts (five on the right and three on the left) were encountered and horizontally incised; anterior cut edges were sutured to adjacent conjunctiva. Small amniotic membrane grafts were required to cover portions of the bulbar surfaces. One small 3mm cyst was excised and histologically found to be consistent with a conjunctival inclusion cyst. One month postoperatively, symblepharon rings were removed with persistent well–formed inferior fornices, normal ocular motility, and no recurrence of the masses. Conclusion:In patients with Stevens–Johnson syndrome marsupialization of palpebral/anterior orbital inclusion cysts can accomplish both elimination of the cysts and reconstruction of the adjacent fornix.

Keywords: autoimmune disease • conjunctiva