Challenges in the management of bilateral eyelid closure in Stevens-Johnson Syndrome

Purpose: To describe the challenges of surgically treating Stevens-Johnson syndrome (SJS) cases with bilateral eyelid closure, a serious ocular sequela. Observations: This study involved two 69-year-old females, with subacute-stage SJS (Case 1 and Case 2), and a 37-year-old male with chronic-stage SJS (Case 3). Case 1 had undergone simultaneous bilateral symblepharon lysis at 4-months post SJS onset, and her logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (VA) (BCVA) improved from 2.8 (both eyes) to 0.7 OD and 0.4 OS. Cases 2 and 3 underwent symblepharon lysis with intraoperative use of mitomycin C (MMC) and amniotic membrane transplantation (AMT) at 9 months (OD) and 11 months (OS) (Case 2) and at 31 years (OD) (Case 3) post SJS onset. At 3-months postoperative, Case 3 underwent cultivated oral mucosal epithelial sheet transplantation (COMET). In both cases, BCVA (logMAR) improved with the postoperative use of limbal-rigid contact lenses (CLs); i.e., from 2.8 to 0.5 OD and 1.2 OS (Case 2) and from 2.8 to 1.1 OD (Case 3). In all 5 treated eyes, eyelid opening and VA were maintained through final follow-up. Conclusion and importance: In severe bilateral symblepharon cases, it can be difficult to predict postoperative outcomes, as proper surgical treatment is often delayed. In SJS cases with bilateral eyelid closure, the surgical intervention strategy of AMT and COMET, combined with limbal-rigid CL wear post surgery, can result in improved vision, and symblepharon surgery might be easier and possibly result in a better prognosis when performed at the early phase.