EYELID COMPLICATIONS OF STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS: DIAGNOSIS, PREVENTION, AND TREATMENT OF OCULAR SEQUELAE

Abstract

Introduction: Stevens-Johnson syndrome and toxic epidermal necrolysis are severe immune-mediated mucocutaneous reactions that may produce acute ocular inflammation and chronic cicatricial eyelid disease. Eyelid margin keratinization, trichiasis, distichiasis, entropion, symblepharon, lagophthalmos, meibomian gland dysfunction, and exposure-related corneal disease represent clinically relevant pathways toward visual morbidity. Objective: The main objective of this systematic review was to analyze the diagnosis, prevention, and treatment of eyelid complications and ocular sequelae in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. Secondary objectives were to evaluate acute-phase predictors of chronic eyelid disease, compare medical and surgical interventions, assess the role of amniotic membrane transplantation, examine long-term ocular surface outcomes, and identify evidence gaps relevant to multidisciplinary care. Methods: A systematic search was planned in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP. Studies published within the last five years were prioritized, with expansion to ten years if fewer than ten eligible studies were identified. Human studies were prioritized, and animal or in vitro data were considered separately only when directly relevant to mechanisms of ocular surface injury. Evidence was synthesized narratively because substantial heterogeneity was expected in populations, definitions, interventions, follow-up, and outcome measures. Results and Discussion: Twenty studies were selected for the final review. The available literature indicates that early ophthalmologic assessment, grading of acute ocular involvement, lubrication, topical anti-inflammatory therapy, removal of pseudomembranes, fornix surveillance, and timely amniotic membrane transplantation may reduce the risk of chronic cicatricial complications. Chronic eyelid disease often requires individualized reconstruction, including epilation, mucous membrane grafting, correction of lid malposition, management of lid margin keratinization, and long-term ocular surface rehabilitation. Conclusion: Eyelid complications in Stevens-Johnson syndrome and toxic epidermal necrolysis are not secondary cosmetic findings, but central determinants of ocular surface failure and visual prognosis. Evidence supports early multidisciplinary intervention and prolonged follow-up, although high-quality comparative studies remain limited. Treatment should be individualized according to disease phase, eyelid architecture, ocular surface inflammation, corneal involvement, and patient-specific functional needs.