Stevens-Johnson Syndrome (SJS) is a rare but serious disorder that affects the skin and mucous membranes, including the eyes. It is often triggered by a severe reaction to medication or, in some cases, an infection. SJS requires immediate medical attention as it can cause long-term vision complications, including blindness, if not treated promptly.
What Causes Stevens-Johnson Syndrome?
SJS is usually triggered by certain medications or infections. The most common culprits include:
1. Medications
- Antibiotics (such as sulfonamides or penicillins)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen
- Anticonvulsants (used to treat epilepsy or mental health conditions)
- Allopurinol (a drug used to treat gout)
In some people, the immune system reacts abnormally to these drugs, leading to widespread inflammation in the skin and mucous membranes.
2. Infections
Certain infections, such as pneumonia, herpes, and Mycoplasma pneumoniae (a bacterial infection that affects the lungs), can also trigger SJS.
3. Genetic and Other Risk Factors
- Genetic predisposition – Some people have specific genetic markers that make them more likely to develop SJS after taking certain medications.
- Weakened immune system – Conditions like HIV or cancer increase the risk of SJS.
Symptoms of Stevens-Johnson Syndrome
SJS usually begins with flu-like symptoms, followed by painful skin reactions. Common symptoms include:
1. Early Symptoms (1-3 days before skin problems appear)
- Fever
- Sore throat
- Cough
- Fatigue and body aches
2. Skin and Mucous Membrane Symptoms
- Painful rash – Starts as red or purple patches that spread and blister.
- Peeling skin – The top layer of skin begins to peel away, similar to a severe burn.
- Sores in the mouth, eyes, and genitals – Can make swallowing, seeing, and urinating painful.
- Eye problems – Red, swollen eyes, and in severe cases, vision loss.
Since SJS affects the skin similarly to burns, it is often treated in burn units at hospitals.
How Does SJS Affect the Eyes?
SJS can cause severe ocular complications, which may result in pain, vision impairment, and permanent damage to the surface of the eye. The cornea, conjunctiva, and eyelids are particularly vulnerable. Common eye-related effects include:
- Red, swollen eyes – Early signs of inflammation that can quickly worsen.
- Severe dry eye – Damage to tear glands can reduce tear production, leading to chronic dryness.
- Corneal ulcers or scarring – The cornea may develop ulcers, and in severe cases, scarring can lead to vision loss.
- Light sensitivity (photophobia) – Due to corneal and conjunctival damage, many patients experience discomfort in bright light.
- Conjunctival adhesions (symblepharon) – The inner eyelid may adhere to the eye’s surface, restricting movement.
- Eyelid abnormalities – Eyelids may become misaligned, or eyelashes may grow inward (trichiasis), causing irritation and further corneal damage.
In severe cases, blindness can occur if the condition is not treated aggressively.
Treatment and Recovery
SJS requires immediate medical attention, as it can become life-threatening. Treatment usually includes:
1. Stopping the Triggering Medication
- If SJS is caused by a medication, stopping it immediately is the first step.
2. Hospital Care
- Patients are often treated in an intensive care unit (ICU) or burn center.
- Intravenous (IV) fluids help prevent dehydration.
- Pain management is crucial.
- Skin care includes wound treatment and sometimes dressings like those used for burn patients.
3. Treating Mucous Membrane Damage
- Special eye drops or antibiotics may be needed for eye infections.
- Mouth ulcers might require numbing solutions to ease discomfort.
4. Medications for Inflammation
- Corticosteroids (in some cases) help reduce inflammation.
- Immunoglobulin therapy (IVIG) may be given to block harmful immune responses.
Possible Complications
Since SJS causes severe damage to the skin and internal tissues, complications can include:
- Sepsis – A life-threatening blood infection.
- Organ damage – Damage to the liver, kidneys, or lungs.
- Permanent vision problems – In severe cases, blindness.
- Chronic skin issues – Scarring and long-term skin sensitivity.
Can SJS Be Prevented?
While SJS can’t always be prevented, there are steps to reduce the risk:
- Avoid known trigger medications if you’ve had SJS before.
- Genetic testing for people with a family history of SJS (especially before taking high-risk drugs).
- Inform doctors about past medication reactions to ensure safer treatment options.
Stevens-Johnson Syndrome is a serious medical condition that can lead to permanent vision damage if not treated promptly. If you develop red, painful eyes, light sensitivity, or blurry vision along with flu-like symptoms or skin reactions, seek immediate medical care. Early intervention by an ophthalmologist is critical in preserving vision and preventing long-term complications.
If you or someone you know has experienced SJS and needs specialized eye care, schedule an appointment with our office to discuss the best treatment and management options for your vision health.