Efficacy of a Timely Amniotic Membrane Grafting in a Case of Steven Johnson Syndrome

Steven Johnson Syndrome, A fatal drug reaction which though rare, has a high morbidity and mortality.48yr male came with sudden onset redness and pain in eyes, fever and rashes on legsand ulceration in oral cavity(developed over few hours)with a 3 day history of intake of Norfloxacin and Carbamazepine for fever and UTI.Systemically- hyperpyrexia, target lesions over lower limb, and ulcerative tender lesions on lips, oral mucosa, tongue and palate. Ocular examination – VA 6/6, lid oedema with ulceration, congestion and extensive forniceal pseudomembranes and a clear cornea.Was diagnosed as SJS and started on iv antibiotics, topical lubricants, steroids andantibiotics. Both eyes underwent AMG within the 1st week with good outcome at 4wk followup. SJS is an acute inflammatory polymorphic disease affecting skin, mucous membranes and eye. Ophthalmic involvement ranges from mild mucopurulent conjunctivitis to severe perforating corneal ulcers in 50% of patients. If untreated in a timely fashion, morbidity occurs with late corneal complications - opacities, vascularization, perforation and ocular surface abnormalities like symblepharon, occasionally leading to blindness.With early presentation and prompt treatment these dreaded complications were prevented and good results achieved.