A team at Moorfields Eye Hospital Dubai (Moorfields) has successfully treated the associated eye conditions for a young patient – an 11 year-old girl of Pakistani origin – who presented with Stevens-Johnson syndrome (SJS), a chronic and serious disease that can affect the eyes permanently and severely.
Stevens-Johnson syndrome is a rare disorder that affects the mucous membranes and the skin, which turns into a painful red or purplish spreading rash that initially blisters, then the top layer of the affected skin dies, sheds and then heals. The cause is not known but it is triggered by a medication reaction or an infection. It is a medical emergency that usually requires hospitalisation, as it is considered a life- threatening disease and the recovery can take weeks to months, depending on the severity of the condition.
Once the first phase of the disease pass and the general health condition is controlled, the eyes damages are better addressed accordingly. In mild cases, this may result in only irritation and dry eyes; however, in severe cases there is an extensive damage of the eye’s surface with consequent scarring, visual impairment and even blindness.
The patient arrived at Moorfields Dubai with intense photophobia (light sensitivity of the eyes) and was unable to open her eyes after trying different types of treatments before with low response.
The patient’s new care regime included a change of the medication to reduce side effects and to improve her ocular surface condition, which included the autologous serum: a type of drop prepared from the patient’s own blood plasma; surgical procedures to block the tear ducts in order to increase the eye’s tear film and surface moisture, in addition to electrolysis – the permanent removal of the inverted eyelashes which were rubbing the cornea.
After a substantial improvement of the ocular surface (with the care mentioned above) among other medications, the team was able to conduct a successful special large diameter (scleral contact lens) trial that is indicated for this condition.
Scleral lenses are normally used to improve vision and reduce pain and light sensitivity for people suffering from a wide range of different disorders in the eye, such as severe dry eye syndrome, microphthalmia, keratoconus, corneal ectasia, Stevens-Johnson syndrome, Sjögren’s syndrome, neurotrophic keratitis (aneasthetic corneas), complications post-LASIK, complications post-corneal transplant and pellucid degeneration, injuries to the eye such as surgical complications, distorted corneal implants, as well as chemical and burn injuries.
These lenses replace the irregular cornea with a near-smooth surface. A special liquid fills the space between the back surface of the lens and the front surface of the cornea. They are fitted with no lens movement during the blink, to keep the liquid intact, which in turn addresses the dry eyes by keeping the cornea moist. These lenses can be worn during the waking hours without any problem.
Following treatment, the patient was able to open her eyes again with much less light sensitivity and no pain, improving the patient condition. The patient’s vision also improved within the limits of this chronic severe disease.
The young patient’s father, who accompanied his daughter from Pakistan, said: “The family is very happy with the results that Moorfields Dubai achieved for our daughter, and the care and expertise the team showed. Our daughter can now open her eyes and is free of the irritation and pain of dry eye, which makes a big difference to the quality of her life.”
Dr Sandra Fiorentini, Specialist Ophthalmologist in External and Dry Eye Disease and Eye Allergies, who is managing the condition of this young patient said: “The severe and long term eye complications of SJS are some of the most challenging conditions to be treated by ophthalmologists and are often overlooked in the patient’s initial care, when they need more urgent general health treatment as it is also a life threatening condition in its immediate serious presentation. It demands a multidisciplinary approach and a cornea specialist ophthalmologist to treat adequately and to ensure regular and long term follow up. The team was very pleased to have improved the patient’s condition, stop the pain in her eyes and to help give her a better quality of life.”
Devakani Suresh Kumar, Senior Optometrist at Moorfields Eye Hospital Dubai, added: “When we first tried to fit scleral lenses, the patient could not tolerate them because of the dry eye irritation but she was very understanding and became more motivated to have the lenses fitted successfully, so we kept trying. After a week of treatment for SJS, we tried the lenses again and she was able to see better over longer distance and even able to read a book at close distance. This was a happy and emotional moment for us all.”