Retinol Palmitate Improves Dry Eye, Keratinization in Stevens-Johnson Syndrome

Individuals with Stevens-Johnson Syndrome (SJS) with ocular surface keratinization can benefit from treatment with retinol palmitate in addition to conventional methods, according to research published in The Ocular Surface. The treatment has the potential to improve dry eye symptoms associated with the disease and reverse ocular surface keratinization, according to the report. 

Researchers included 23 patients with SJS who were treated with retinol palmitate in addition to conventional therapies (n=11; eyes, 22; median age, 25 years) or conventional treatments alone (n=12; eyes, 22; median age, 24.5 years) in the 2-year, comparative intervention study. Study participants underwent visual acuity measurement, Schirmer testing, tear breakup time (TBUT) assessment, anterior segment examination, and ocular surface staining at baseline and 12-week follow up. The investigators performed corneal and conjunctival cytology on all participants, and study individuals reported subjective dry eye symptoms using the Ocular Surface Disease Index (OSDI). 

Treatment with retinol palmitate significantly improved Schirmer-1 test scores (P <.01), corneal staining (P =.01), conjunctival staining (P <.01), ocular surface keratinization on impression cytology(P =.01), and reported OSDI scores (P =.04) compared with individuals receiving conventional therapies, the report shows. Goblet cells, which were absent in both groups at baseline, were noted following retinol palmitate treatment, and their number increased at 1 month before decreasing at the 12-week follow up.

Visual acuity, TBUT, inflammatory cells on impression cytology, and the inflammatory markers in tears were not significantly different between the 2 groups, according to the report. 

“[R]etinol palmitate is a safe drug with minimal adverse drug events,” according to the researchers. “Incorporation of the drug into the treatment regimens of patients with chronic Stevens-Johnson syndrome with keratinization could be beneficial.”

However, the study authors acknowledge that the improvements in ocular surface cytology are transient and additional interventions may be needed to support the growing cells observed in patients treated with retinol palmitate. 

Study limitations include a lack of treatment randomization and the use of nonspecific stain for staining goblet cells.