05/06/2026
Stevens Johnson syndrome is a rare, severe immune mediated condition, most often triggered by medications, that can result in devastating long term ocular surface disease.
In the chronic phase, patients may develop significant scarring, symblepharon, severe dryness, limbal stem cell deficiency, and progressive vision loss. These cases are often some of the most challenging we manage.
This 62 year old male developed Stevens Johnson syndrome as a child secondary to penicillin. His ocular history is significant for keratolimbal allograft in 2017. He is now monocular due to severe symblepharon resulting in complete eyelid closure in the fellow eye.
Fitting was particularly challenging due to:
• Significant symblepharon
• Very flat cornea
• Severe conjunctival profile irregularity
Given this level of complexity, impression based design was the best option to accurately capture the ocular surface and achieve appropriate alignment.
We prescribed a scleral lens along with autologous serum placed in the bowl prior to application. His best corrected vision in the scleral lens is 20/60.
In Stevens Johnson syndrome, scleral lenses serve a critical therapeutic role beyond vision. The fluid reservoir continuously bathes the cornea, reduces mechanical trauma from the lids, and helps maintain epithelial integrity in an otherwise compromised surface.
For these patients, aggressive lubrication is essential, and scleral lenses function as a protective environment to support long term ocular surface health and preserve functional vision.
visionrehabilitation
