Abstract
Purpose :
Stevens-Johnson Syndrome (SJS) is a severe hypersensitivity reaction affecting skin and mucous membranes with potentially debilitating ocular sequalae. Acute ocular severity (AOS) may correlate with long-term ocular outcomes. AOS can progress rapidly and early ophthalmology consultation (OC) is of paramount importance. We performed a retrospective, observational chart review to clarify the relationship of AOS and initiation of ophthalmologic care.
Methods :
All patients with history of SJS in our hospital system were considered. Included patients had documented confirmed SJS diagnosis by biopsy or clinical exam by dermatology or burn service. 127 patients were included. The outcome measures included frequency of OC in the acute phase, AOS score at initial OC, and length of time in days to first OC. AOS score was compared between those seen within 1 day of admission and those seen after 1 day. Statistics were performed in R version 4.0.2. Means with standard deviations are presented for ordinal variables.
Results :
85 (66.9%) patients were seen by ophthalmology within 1 day, 26 (20.5%) were seen after 1 day, and 16 (12.6%) were not seen. Those seen occurred at a mean of 1.47 days after admission. Greater AOS scores were present in those seen within 1 day of admission compared to those seen after 1 day (p = 0.003). Worse systemic disease was seen in those patients seen within 1 day versus after 1 day. 23% of eyes in patients seen after 1 day of admission went on to develop chronic disease complications.
Conclusions :
Most patients with SJS were seen by ophthalmology during the early acute phase. More severe eye disease was noted in those seen within 1 day of admission. As the workup of SJS is complex, often requires biopsy, and therefore increases time to diagnosis, this finding suggests more significant acute ocular and/or systemic disease may prompt more expedient ophthalmologic care when SJS is suspected. However, those not seen within 1 day of admission still have significant chronic complications. While large improvements have been made in the practice of OC for SJS, we suggest that all patients suspected of having SJS/TEN be examined by ophthalmology as early as possible as ocular disease can rapidly progress and even initially mild cases can have chronic complications.
This is a 2021 ARVO Annual Meeting abstract.