Limbal-Rigid Contact Lenses Stabilize Ocular Surface in Stevens-Johnson Syndrome

Limbal-rigid contact lenses can stabilize the ocular surface and improve visual acuity in patients with Stevens-Johnson syndrome (SJS) or toxic epidermal necrosis, according to a study published in Eye & Contact Lens. 

Researchers retrospectively reviewed data from 41 individuals with SJS (63% women; mean age, 49.0 years; eyes, 50) who underwent limbal-rigid contact lens therapy for more than 2 years (mean, 4.3 years). All patients underwent anterior segment evaluation and visual acuity (VA) assessment. The team used a 4-point scale to score conjunctival hyperemia, corneal neovascularization and upper tarsus scarring severity (0, absent; 3, very severe for all). Study participants were evaluated at baseline and during 3-, 6-, and 12-month visits before presenting annually for follow-up for a mean 4.3 years. 

Limbal-rigid contact lens wear improved mean conjunctival hyperemia (1.14 vs 0.86; P <.01) and corneal neovascularization scores (2.10 vs 1.98) at 3-month follow up visits compared with baseline. No instances of worsening were reported for either condition, and 96.9% of participants had a conjunctival hyperemia score between 0 and 1 at 5-year follow-up.  

Participants’ VA improved immediately after initiating therapy (mean difference, −0.56 logarithm of the minimum angle of resolution [logMAR]; P <.01). Overall, 49 of 50 eyes experienced VA improvements, and vision remained unchanged in the 1 remaining eye. 

A small subgroup of participants (n=6) underwent tear cytokine analysis at baseline and at a minimum 3 months after initiating limbal-rigid contact lens treatment. The report shows that the level of several cytokines decreased. 

The study authors explain the mechanism through which limbal-rigid contact lenses improve VA and ocular surface conditions. 

“Poor VA is partly because of the ocular surface irregularities and corneal opacity caused by inflammation that occurs at the acute phase of SJS/[toxic epidermal necrosis],” according to the researchers. “Wearing a limbal-rigid [contact lens] is believed to improve VA through the formation of a fluid layer behind the lens, which corrects optical distortion and improves irregular astigmatism and corneal opacity, similar to when other scleral lenses are worn.”

Study limitations included a small sample size and variability in cytokine levels in the subgroup assessment.