Gabapentin
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Ocular complications secondary to Stevens-Johnson syndrome: case report. A woman in her late 40’s developed ocular complications secondary to Stevens-Johnson syndrome during treatment with gabapentin for chronic neck pain. The woman presented with slow loss of visionin bilateral eyes since 9 months. Additionally, she had dryness in both eyes, photophobia and difficulty in moving around without help. Ten months previously, she was admitted for 2 weeks due to oral ulcers, loss of nails, bilateral conjunctivitis and skin peeling off after oral administration of gabapentin for severe neck pain [dosage not stated]. She was diagnosed with Stevens-Johnson syndrome due to gabapentin [duration of treatment to reaction onset not stated]. After discharge, she had slow vision loss in both eyes. She was diagnosed with bilateral corneal melt. During the presentation, she had absence of nails on all four extremities, several hypopigmented patches on her face and lip synechiae. Her visual acuity (VA) was perception of light in both eyes (BE). She was using artificial tears in BE very frequently throughout the day. Slit-lamp examination showed right eye (RE) corneal vascularisation with conjunctivalisation of the cornea with a large persistent epithelial defect inferiorly accompanied by lid margin keratinization (LMK). The left eye (LE) had total symblepharon with the upper lid adhered to the inferior cornea- through little view of the inferior cornea, the cornea looked clear. LMK was noted in both the upper and lower lids. Digital tension was normal and fundus could not be visualised in BE. B-scan ultrasound confirmed an attached retina in BE. She was diagnosed with chronic ocular sequelae secondary to Stevens-Johnson syndrome in both eyes, with left eye total symblepharon, right eye total limbal stem cell deficiency with severe dry eye and keratinisation in all four lids. Subsequently, the woman underwent left eye symblepharon release with autologous labial mucous membrane grafts (MMGs) for surface reconstruction and subsequent lid margin MMG for lid margin keratinization. Post-surgery, she received unspecified steroids and antibiotics for corneal oedema. Her best-corrected visual acuity improved to 20/25 with insertion of scleral lens in the left eye. In follow up after 1 year of the surgery, she was ambulatory. She continued the use of artificial tears for dry eyes and the scleral lenses. She had no recurrence of lid margin keratinisation or symblepharon, and her vision was maintained. Sudana P, et al. Oral mucous membrane grafts for total symblepharon and lid margin keratinisation post Stevens-Johnson syndrome. BMJ Case Reports 13: no pagination, No. 803518759 10, 31 Oct 2020. Available from: URL: http://doi.org/10.1136/bcr-2020-239383
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Reactions 5 Dec 2020 No. 1833
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