Use of amniotic membrane at outpatient conditions for acute ocular surface involvement of Stevens-Johnson syndrome

The purpose of the study is to present a case of Stevens-Johnson syndrome (SJS) with acute ocular surface involvement, who was managed by amniotic membrane application in outpatient clinic conditions. A 68-year-old female patient with a diagnosis of acute SJS, under topical skin therapy as well as intravenous steroid and immunoglobulin treatment at the Dermatology Service, was consulted for ocular involvement with red eyes and secretion in both eyes. At the initial examination, her visual acuities were counting fingers from 1 m in the right eye and from 10 cm in the left eye. In addition to bilateral pseudomembranous conjunctivitis, corneal epithelial irregularity and an epithelial defect of approximately 4 mm × 6 mm were present in the right and left eyes, respectively. Amniotic membrane was applied to the left eye with a sutureless ring (Amnioring®) that fits at the fornices, at outpatient clinic conditions. Topical treatment with steroids, cyclosporine, and hyaluronic acid eyedrops was commenced. During follow-up, a dramatic improvement in ocular surface inflammation was observed; chemosis regressed. The cornea was epithelialized preserving the stromal transparency. Keratinization at the eyelid ciliated margin, symblephora formation, corneal vascularization, and cicatrization was not observed. Topical steroid therapy was tapered; the patient was followed-up by reducing the doses of cyclosporine and hyaluronic acid. SJS has a poor prognosis in terms of corneal transplantation and keratoprosthesis surgeries. In patients at the acute stages of the disease, who cannot be admitted to operating room conditions, sutureless amniotic membrane application in outpatient clinic or even intensive-care unit conditions should be considered. This is a promising method, to prevent both short- and long-term complications of the ocular surface and irreversible corneal blindness.