Purpose: To investigate the details of the long-term progression of ocular surface cicatrization in eyes with ocular sequelae caused by Stevens–Johnson syndrome (SJS)/toxic epidermal necrosis (TEN). Methods: In 105 eyes of 66 patients with SJS/TEN, the severity of ocular sequelae was retrospectively evaluated using an ocular surface grading score (OSGS) at 2 time points separated by a greater than 5-year interval. The OSGS included 7 ocular surface components (conjunctivalization, neovascularization, opacification, keratinization, symblepharon, and upper/lower conjunctival-sac shortening) evaluated into grades 0 to 3 (maximum total OSGS: 21), with the worsening of each component and total OSGS evaluated at the greater than 5-year interval. Moreover, we evaluated whether upper-tarsus and lid-margin scarring are factors that affect ocular surface cicatrization progression. Results: In 35 (33.3%) of 105 eyes, the total OSGS worsened during the follow-up period. Partial conjunctivalization (score 1–2) progressed more frequently to total conjunctivalization (score 3) than to no conjunctivalization (score 0) (OR [95% CI]; 5.6 [1.6–20.3]). Partial keratinization (score 1–2) also had a high risk of progression into total keratinization (41.0 [6.3–266.5]). In all cases, keratinization progressed only in the eyes with total conjunctivalization (conjunctivalization score 3). Severity of upper-tarsus scarring or lid-margin scarring affected the worsening of the total OSGS. Conclusions: In 66 patients with chronic-phase SJS/TEN, ocular surface cicatrization progressed in 33.3% of the 105 eyes during the long-term follow-up period of over 5 years. More than 50% of the partial conjunctivalization eyes progressed toward total conjunctivalization. The partial keratinization eyes had a high possibility of progressing to total keratinization; that is, the so-called “end-stage” status.

This study aimed to clarify predictive biomarkers of mild and severe ocular complications of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) by examining the cytokines in tears. In 121 chronic-phase SJS/TEN eyes, cytokines in tear samples collected using Schirmer test strips were measured, and ocular sequelae severity was evaluated using an Ocular Surface Grading Score (OSGS) involving 7 components (conjunctivalization, neovascularization, opacification, keratinization, symblepharon, and upper/lower conjunctival-sac shortening), with findings categorized into grades 0–3 (maximum total OSGS: 21). Changes in cytokines between the mild and severe groups (mild: total OSGS of 10 or less, severe: total OSGS of 11 or more), and changes between SJS/TEN cases with and without each of the 7 components, were compared. In the severe group, there was significant upregulation of interleukin (IL)-8 (P < 0.01) and Granzyme B (GrzB) (P < 0.05). IL-8 was significantly upregulated in eyes with conjunctivalization, neovascularization, or opacification, GrzB was upregulated in eyes with keratinization, interferon-γ-inducible protein 10 (IP-10) was downregulated in eyes with conjunctivalization or neovascularization, and IL-1α was upregulated in eyes with opacification (all: P < 0.05). IL-8 and IP-10 was involved in conjunctivalization and neovascularization, while GrzB was involved in keratinization. IL-8 and GrzB in tears may reflect SJS/TEN-related ocular sequelae severity.

The aim of this study was to assess eye pain between dry eye (DE) subtypes using questionnaires and the PainVision® (Osachi) apparatus. This study involved 52 eyes of 52 DE patients with eye pain (43 females and 9 males; mean age: 64.2 ± 13.2 (mean ± SD) years) who were classified into three DE subtypes (aqueous deficient DE (ADDE); decreased wettability DE (DWDE); and increased evaporation DE (IEDE)) based on fluorescein breakup pattern. In all subjects, severity of eye pain was evaluated using PainVision®, the DE-symptom-questionnaire visual analog scale (DSQ-VAS), and the Short-Form McGill Pain Questionnaire 2 (SF-MPQ-2). The severity of eye pain was compared between the three DE subtypes. PainVision® findings revealed greater severity of eye pain in ADDE and DWDE than in IEDE (p < 0.05, respectively), despite no difference being found in each questionnaire. A significant correlation was found between eye pain in DSQ-VAS and continuous pain, intermittent pain, neuropathic pain, and total pain in SF-MPQ-2 (R = 0.50, 0.49, 0.47, and 0.56, respectively) (all: p < 0.001). Greater severity of eye pain was found in ADDE and DWDE than in IEDE, and PainVision® was found useful for the objective assessment of eye pain.