Taking a look at ocular complications in SJS/TEN: Identification of clinical markers of disease severity

Leon Zhang, Christopher Chew, Adithya Shastry, Dale Jobson, Zhao Feng Liu, Miki Wada, Zhengyang Liu, Ella Ryan, Nidhin Kuruvilla, Lawrence Lin, Johannes Kern, Sarah Smithson, Michelle Goh, Douglas Gin

Aim: Steven-Johnson Syndrome (SJS) and Toxic Epider­mal Necrolysis (TEN) are a spectrum of severe mucocutaneous reactions. SJS/TEN can result in a multitude of Severe ocular complications (SOCs) and irreversible vision loss. Acute ocular involvement is a known predictor of chronic ocular sequelae, but there is a paucity of evidence on the use of early ocular manifestations to predict the course of disease. This study aims to explore the use of acute SOCs to predict the course of SJS/TEN._x000D_
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Method: We conducted a single-centre retrospective cohort study (n = 83) on adult patients treated for SJS/TEN. Patients were classified by their Severe Cutaneous Adverse Reaction (SCAR) type (SJS, TEN or SJS/TEN overlap) on presentation and discharge into “mild” (SJS or SJS/TEN at presentation without progression to TEN), “moderate” (SJS or SJS/TEN at presentation with progression to TEN) and “severe” (TEN at presentation) disease. We compared the incidence of SOCs between patients who did and did not progress in severity during admission._x000D_
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Results: 25 patients developed 1 or more SOCs. 2 patients were not assessed for SOCs. In total, 25 (n = 83) were classified to have severe disease. 40 patients had mild disease. Initial ocular sloughing is more common in patients with severe disease, compared to patients with mild disease (OR = 5.833, 95% CI = 1.0675–31.8774, p = 0.0418). The presence of ocular complications did not predict progression to TEN from SJS or SJS/TEN (OR = 1.3641, CI = 0.6949–2.6778, p = 0.3669)._x000D_
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Conclusions: Ocular sloughing is associated with disease severity and the diagnosis of TEN compared to milder cases of SJS or SJS/TEN status that do not progress to TEN. In future, we plan to explore the prevalence of chronic ocular complications in our cohort and its association with acute SOCs._x000D_
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