Lacrimal Drainage System Involvement in Stevens-Johnson Syndrome:A Case Report and Literature Review

Abstract

Stevens-Johnson-Syndrome (SJS) is characterized by severe inflammation of the skin and mucous membranes of
the entire body. Also known as Lyell disease, the effect of the disease is usually quite fatal if not aggressively
managed. The lacrimal drainage system which is lined inside by the mucous membrane is also not spared and when
involved the management is challenging. We report a 31-year-oldretroviral disease positive female on antiretroviral
drugs whose consent was sought and permission granted. She presented with severe symblepharon occluding the
puncta of the upper and lower lids, associated with persistent epiphora and bacterial blepharitis in both eyes, with
good visual acuities and multiforme erythematous skin eruptions. The probing of the system revealed soft stops
along the canalicular and naso-lacrimal duct segments of the lacrimal drainage systems. There was failed venflon
stenting procedure after symblepharon release warranting bilateral dacryocystorhinostomies (DCRs) with silicone
intubations which was followed by marked relief of symptoms and signs. We therefore conclude that SJS can affect
the lacrimal drainage systems and the management challenges are enormous requiring a lotof resilience and
patience on the side of the oculoplastic surgeon.