Purpose: To look at the correlation between many factors (time of hospitalizat ion, floppy eyelid syndrome, trichiasis, open lacrimal puncta, symblepharon, and aqueous tear deficiency)-and corneal complications in Stevens-Johnson syndrom e (SJS). Design: Observational cases series. Patients: Clinical data were retros pectively reviewed from 38 patients (32.7±20.1 years old) with SJS (n=11) and with toxic epidermal necro lysis (TENS) (n=27) from January 2002 to August 2004. One case report with SJS w as included to verify the presence of tarsal/lid margin ulceration at the acute stage. Methods: The medical history was retrieved regarding presumed causative m edications used within 15 days and the duration of hospitalization. Data of the latest photographic documentation and eye examination were compared and correlat ed in a masked fashion. Main Outcome Measures: Floppy eyelid, trichiasis, lid ma rgin keratinization, meibomian gland orifice metaplasia, symblepharon, tarsal sc ar, and corneal complications. Results: Acute SJS/TENS was characterized by tars al conjunctival ulceration. Keratinization of the eyelid margin with variable de grees of meibomian gland dysfunction was observed in all cases. Floppy eyelid, t richiasis, partially or totally opened lacrimal punctum, symblepharon, and aqueo us tear deficiency were not significantly correlated with corneal complications. In contrast, there was a strong correlation between the severity of eyelid marg in and tarsal pathology and the extent of corneal complications (Spearman r, 0.5 4; P=0.0005). A multivariable regression analysis also showed that the extent of eyelid and tarsal pathology had a significant effect on corneal complications ( coefficient, 0.84; P=0.006). Conclusions: Patients with acute SJS/TENS are chara cterized by severe inflammation and ulceration of the tarsal conjunctiva and lid margins. If left unattended, lid margin keratinization and tarsal scar, togethe r with lipid tear deficiency, contribute to corneal complications because of bli nk-related microtrauma. Attempts to suppress inflammation and scarring by amnio tic membrane transplantation at the acute stage and to prevent microtrauma at th e chronic stage are vital to avoid sight-threatening complications.
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