Ocular Surface Failure in Stevens–Johnson Syndrome – Etiopathogenesis and Management Protocols

Abstract

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but devastating immune-mediated mucocutaneous disorders, characterized by extensive epithelial apoptosis. Ocular involvement is common and represents the leading cause of long-term morbidity among survivors. Increasing evidence demonstrates that the severity and adequacy of acute ophthalmic management, particularly control of eyelid margin inflammation, largely determine chronic outcomes. Despite advances in systemic care, delayed or inadequate ocular intervention frequently results in chronic cicatrizing ocular surface disease, limbal stem cell deficiency, and corneal blindness. This review provides a comprehensive overview of ocular SJS/TEN, integrating current understanding of immunopathogenesis, genetic susceptibility, acute protocol-based management strategies, and the full spectrum of surgical and nonsurgical options for chronic disease. Emphasis is placed on amniotic membrane transplantation, eyelid margin reconstruction, ocular surface stabilisation, and end-stage visual rehabilitation, highlighting the critical importance of early ophthalmologic involvement to prevent irreversible blindness.