# Surgical management of chronic Stevens-Johnson syndrome

## TL;DR

This paper reviews surgical strategies for managing chronic Stevens-Johnson Syndrome, focusing on preserving the ocular surface and restoring vision.

## Contribution

The paper provides a comprehensive review of evidence-based surgical interventions for chronic ocular complications of Stevens-Johnson Syndrome.

## Key findings

- Punctal occlusion, mucous membrane grafting, and amniotic membrane transplantation are effective for managing tear film instability and promoting healing.
- Advanced techniques like COMET and MSGT are recommended for severe cases of ocular surface dysfunction.
- Tailored surgical plans improve outcomes by addressing surface preservation, structural correction, and visual restoration.

## Abstract

Stevens-Johnson Syndrome (SJS) is a rare but severe mucocutaneous disorder that often leads to chronic ocular complications, requiring a comprehensive and multidisciplinary approach to management. This review outlines the pathophysiology and long-term ocular sequelae of SJS and discusses evidence-based strategies for stabilizing the ocular surface and restoring visual function. Key interventions include punctal occlusion to address tear film instability, mucous membrane grafting (MMG) for lid margin reconstruction, and amniotic membrane transplantation (AMT) to promote epithelial healing and reduce inflammation. Cultivated oral mucosal epithelial transplantation (COMET) and minor salivary gland transplantation (MSGT) serve as advanced options for restoring ocular surface function in severe cases. The correction of cicatricial entropion, often seen in chronic SJS, involves techniques such as anterior lamellar repositioning with or without grafting, which restore lid alignment and reduce ocular trauma. Visual rehabilitation through cataract surgery or keratoprosthesis demands careful preoperative planning due to the fragile ocular surface and heightened risk of postoperative complications. A tailored, staged management plan focused on surface preservation, structural correction, and visual restoration is essential to improve outcomes and quality of life for patients with chronic ocular SJS.