Conjunctiva
Stevens-Johnson Syndrome / TEN (Acute Ocular Involvement)
Also known as: acute SJS, SJS TEN acute, toxic epidermal necrolysis acute, acute ocular SJS, drug reaction eye emergency, mucocutaneous blistering eye
Filed as: Emergency
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Acute Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) with ocular involvement — a life- and sight-threatening drug/immune mucocutaneous emergency, distinct from the chronic ocular sequelae seen years later. In the acute phase the ocular surface undergoes epithelial sloughing, pseudomembrane and symblepharon formation, and conjunctival/corneal breakdown over days. Any patient with a widespread mucocutaneous blistering reaction and eye redness, pain, discharge, or lid/conjunctival membranes needs same-day ophthalmology assessment for acute-phase grading and surface protection; the systemic illness is managed in hospital (often burns/ICU). Common triggers: sulphonamides, anticonvulsants (lamotrigine, carbamazepine, phenytoin), allopurinol, NSAIDs, and some antibiotics.
Recognition
Symptoms: what patients report
- Acutely red, painful, watering eyes in a systemically unwell patient.
- Photophobia and blurred vision.
- Gritty, raw sensation; difficulty opening the eyes.
- Sore mouth, lips, throat, or genital mucosa; skin rash or blistering.
Signs: what the examination shows
- Severe conjunctival hyperaemia, often bilateral.
- Conjunctival membranes or pseudomembranes.
- Epithelial defects / sloughing of the conjunctiva or cornea.
- Lid-margin ulceration and crusting.
- Early symblepharon (adhesion between palpebral and bulbar conjunctiva) forming in the acute phase.
- Associated skin detachment and mucosal ulceration (systemic examination).
What OptoGuide™ covers for stevens-johnson syndrome / ten (acute ocular involvement)
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Stevens-Johnson Syndrome — EyeWiki
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- Severe Cutaneous Adverse Reactions to Drugs. Duong TA, Valeyrie-Allanore L, Wolkenstein P, Chosidow O. Lancet (London, England). 2017;390(10106):1996-2011.
- Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Miller JM, Binni
- Japan: Diagnosis and Management of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications. Sotozono C, Ueta M, Kinoshita S. Frontiers in Medicine. 2021;8:657327.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.