Paediatric Ophthalmology: Case three

Figure 1

Figure 2


This 10 year old school boy presented to the casualty with these recurrent lesions. Each attack was preceded by the appearance of cold sore of the lips

a. What is the diagnosis?

Steven-Johnson's syndrome.

This syndrome consists of erythema multiforme with mucous memebrane involvement. It can be precipitated by various agents including:

    • infection especially Mycoplasma pneumoniae and herpes simplex
    • drugs such as sulphonamide, phenytoin, penicillin etc
    • malignancy
The condition is thought to be due to type III hypersensitivity reaction. Immunopathology study of the lesions shows deposition of Ig A complexes with lymphocytic infiltration.

b. What ocular treatment is recommended?

    There is no agreed therapy for the ocular problems. However, the following are suggested:
      • topical antibiotic to prevent superinfection
      • topical steroid to reduce the inflammation
      • presence of symblepharon can be broken under local anaesthesia to prevent led distortion. The use of lubricant also reduces the incidence of symblepharon
c. Would there be any long-term ocular sequelae?
    In severe or recurrent cases, the following may occur:
      • lid distortion due to symblepharon, scarring and entropion
      • keratoconjunctivitis sicca from goblet cell dysfunction
      • corneal scarring or ulceration from a combination of dry eyes and entropion

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