Study details ocular complications of drug-induced Stevens-J
This study compared the severity of chronic ocular complications of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) triggered by lamotrigine (LT) and trimethoprim-sulfamethoxazole (TS).

Researchers enrolled 24 patients diagnosed with SJS/TEN due to the use of lamotrigine or trimethoprim-sulfamethoxazole between 2008 and 2018 and who had at least 1 ophthalmic chronic follow-up 3 or more months after diagnosis. Researchers noted chronic complications such as a prosthetic replacement of the ocular surface ecosystem device, an eyelid mucous membrane graft, or a keratoprosthesis. They also compared visual acuity before and after treatment with lamotrigine or trimethoprim-sulfamethoxazole.

The lamotrigine group had significantly worse visual acuity than the trimethoprim-sulfamethoxazole group (0.51 vs. 0.04 logMAR) and a higher prevalence of severe ocular complications (67% vs. 8.3%). The lamotrigine group also scored worse on Sotozono severity scores—developed to describe the severity of ocular complications in Stevens-Johnson syndrome—for cornea, eyelid margin, and overall condition; however, the conjunctiva score was similar in both study arms.

This study was based on anecdotal evidence that some of the worst cases of Stevens-Johnson syndrome/toxic epidermal necrolysis ophthalmic disease are induced by lamotrigine. A better understanding of the drug types that cause ocular manifestations of Stevens-Johnson syndrome/toxic epidermal necrolysis can allow for better treatment of patients in the acute phase of disease before catastrophic complications arise.