Stevens-Johnson Syndrome Associated With Meibomian Gland Alterations

Stevens-Johnson Syndrome
Stevens-Johnson syndrome (SJS), a form of toxic epidermal necrolysis, is a life-threatening skin condition, in which cell death causes the epidermis to separate from the dermis. The syndrome is thought to be a hypersensitivity complex that affects the skin and the mucous membranes. Conjunctivitis is a symptom.
Clinicians treating SJS should consider the need to assess meibomian gland structural and functional parameters.

Stevens-Johnson syndrome (SJS) is associated with reduced structural and functional meibomian gland parameters, contributing to a worsening in dry eye symptoms, according to a study published in the American Journal of Ophthalmology.  

Researchers assessed 120 eyes from 60 patients with SJS (mean age 31.08±12.94 years, 35 women, 25 men) and accompanying chronic ocular sequelae between July 2019 and January 2020. The team administered the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire to all participants and performed measurements of tear osmolarity, keratography, ocular surface interferometry, corneal staining, meibum expression score, (MES, 0-3) and meibum quality score (MQS, 0-3). The investigators calculated the meibomian gland dropout area (meiboscore) for the upper and lower eyelids and graded the images on a scale from 0-3. 

Researchers noted that adverse drug reaction was the most frequent cause of SJS (n=51, 85%). The mean tear osmolarity, lipid layer thickness (LLT), Schirmer’s test-1, and tear break-up time were 322.70±17.82 mOsm/l, 53.07±27.0 nm, 6.62±5.74 mm, and 3.38±1.90 s, respectively, among the cohort. The investigators also observed severe meibomian gland loss in 65% of eyelids and noted no statistically significant difference in the grades of meibomian gland loss among the upper and lower eyelids (Upper eyelid meiboscore: 2.54±0.72 and Lower eyelid meiboscore: 2.52±0.72; P =.158). Approximately 61% of eyelids had no expressible glands. 

Meiboscore was positively correlated with SPEED, corneal staining scores, MES, and MQS (P <.001 for all). LLT showed a negative correlation with SPEED (P <.01), meiboscore (P <.001), MES (P <.01) and MQS (P <.001). Over 80% of the eyes had a dry eye severity grade of 3-4, according to DEWS dry eye classification system.  

Ocular sequelae associated with this disease results in “global ocular surface damage including dry eye,” according to the investigators. “This study highlights the need to evaluate meibomian gland structure and function in patients with chronic ocular sequelae of SJS.”

Study limitations include a small sample size, single center design, and the absence of a control group.   


Panjiyar M, Sadhu S, Shobha PS, et al. Structural and functional evaluation of meibomian glands and its correlation with dry eye parameters in Stevens-Johnson syndrome (SJS). Am J Ophthalmol. Published online March 11, 2022. doi:10.1016/j.ajo.2022.03.004