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History - About syndrome should be treated?1. Systemic treatment of toxic epidermal necrolysis, Stevens-Johnson syndrome, type of treatment more difficult, such lesions in patients with more severe and require special care and medication, is particularly critical of the fluid balance, respiratory function, nutritional status careful monitoring and lesion site care, such patients should be sent to the intensive care unit treatment and maintain fluid balance in patients is crucial.
More than 50% of patients died of toxic epidermal necrolysis, sepsis, inflammation control is therefore crucial, the general of the culture-positive patients with sepsis should be based on the results of drug sensitivity test antibiotic selection, partial loss of skin silver nitrate solution can be used wet packing, covering biological, such as body skin, pig skin, amnion can play in local cover for pain relief, prevention of infection.
Glucocorticoids in Stevens-Johnson syndrome, toxic epidermal necrolysis in patients with the application, at present still controversial, some studies showed that high doses of corticosteroids may improve necrolysis, and to promote healing in patients, systemic glucocorticoid Hormone doses of up to: prednisone 40mg / d or methylprednisolone 750mg / d, due to lack of efficacy of glucocorticoid conclusive evidence, so some other scholars believe that serious cases of skin lesions should not use corticosteroids, and sugar corticosteroids does not affect the pro


gnosis of patients, some patients even after the use of corticosteroids may be the phenomenon of deterioration.
Stevens-Johnson syndrome, toxic epidermal necrolysis, a greater change in the course of disease, it also makes use of corticosteroids is more difficult, due to the existence of various complications of hormone application such as infection, gastrointestinal bleeding, wound healing, duration of extension and pus sepsis drugs, so glucocorticoids in severe Stevens-Johnson syndrome, toxic epidermal necrolysis in patients with the application to specific conditions.
2. Eye Stevens-Johnson syndrome therapy in the acute stage, the eye should be kept clean, including the conjunctival sac of the frequent balanced salt solution irrigation and prophylactic antibiotic use, In addition, the frequency of artificial tear eye is also conducive to the maintenance of corneal epithelial the integrity of the Stevens-Johnson syndrome caused by anterior uveitis may consider using cyclophosphamide.
Topical corticosteroids have not yet determined the significance, often applied in a secondary infection, the application of corticosteroids may alleviate symblepharon, can play a role in reducing inflammation, for the application of glucocorticoids, should be carefully and close observation of the occurrence of complications, if there is corneal inflammation, pathogen should be cultured and use of effective antibiotics, the efficacy of topical cyclosporine has not been determined.
If corneal perforation, can be considered lamellar keratoplasty or penetrating keratoplasty during the acute phase, you can also use the conjunctival flap to cover the ocular surface, and try to make the separation symblepharon, but easily repeated symblepharon You can use bandages or symblepharon Saran ring-type lens in combination with a bandage to prevent symblepharon You can also use plastic bandages, use the mattress suture in the conjunctival fornix Saran Department of bandage, plastic bandage may have been use to the end of the acute phase, and its tolerability in children than symblepharon ring and bandage-type lenses.
3. Chronic eye diseases, treatment of chronic Stevens-Johnson syndrome, toxic epidermal necrolysis, treatment is difficult, but more difficult to deal with trichiasis, the doctor can be removed, frozen, argon laser, electrolysis, eyelash tarsal incision, to destroy , palpebral margin of -20 ~ -30 Freezing can destroy more than 80% of the eyelashes, the doctor may, after the probe placed in the palpebral part 2 ~ 3mm of the conjunctiva, the organization needed to achieve the optimum temperature for time to 40 ~ 60s, the two should be made between sub-freezing from time to time between the thawing period.
Cicatricial entropion and skin of the conjunctiva can result in corneal damage, for the correction of entropion and viable mucosa graft combined varus correction, may occur in chronic nasolacrimal duct obstruction, lacrimal duct obstruction and lacrimal duct stenosis, and sometimes These can prevent the appearance of dry eye without the need correction, and sometimes also appear dacryocystitis or epiphora phenomenon, then the need for lacrimal silicone tube insertion and dacryocystorhinostomy.
Stevens-Johnson syndrome, toxic epidermal necrolysis in patients with conjunctival scarring and scar management after lacrimal keratoconjunctivitis dryness, use artificial tears to the appropriate treatment, doctors can use preservative free eye methyl cellulose preparations, because the preservative may increase in some patients with dry eye.
Topical application of corticosteroids to help control inflammation, prevent further symblepharon, some mucosal solvent such as N-acetylcysteine can inhibit the formation of mucus and abnormal mucus thsecretion, In addition, the lateral and medial eyelid margin of suture to the ocular surface by reducing the effective evaporation area to improve the eye symptoms, bandage-type lenses help protect the cornea and prevent permanent corneal epithelial defect, as these patients with poor ocular surface, mucin secretion decreased So doctors should closely observe whether the lens close to the syndrome (tight lens syndrome) the emergence of a bandage-type lenses easily lead infectious keratitis.
Local and systemic application of vitamin A can improve the Stevens-Johnson syndrome in patients with ocular surface status of children, which has a therapeutic role in the topical application of vitamin A substances (retinoid) in patients after the onset of symptoms can be reduced, visual acuity, Bangladesh red staining, Schirmer test has changed, and squamous metaplasia can be topical application of 0.01% and 0.05% vitamin A eye ointment 2 times / d painted eyes, the application of vitamin A can increase the incidence of eye infections and blepharitis , to reduce the side effects can gradually reduce the dosage.
In dealing with the Stevens-Johnson syndrome, toxic epidermal necrolysis caused permanent corneal epithelial dysfunction, the possible angioplasty corneal epithelium, the receptor after removal of corneal superficial lines, the donor corneal graft placed in the same location At this time, corneal epithelial cells and can be extended to cover the cornea and conjunctiva receptor.
Once the epithelial growth and stability, you can of corneal transplantation to improve vision and remove corneal scarring, the major complications in these patients, including drug-induced corneal epithelial damage, lack of trichiasis and mucin.
For those poor corneal epithelial healing in patients with Stevens-Johnson syndrome, the trial may be considered artificial cornea, artificial cornea of the major complications, including eyelid cellulitis, artificial cornea prolapse, aqueous leakage, artificial corneal membrane, endophthalmitis, and for glaucoma, etc., the choice of treatment should be fully taken into account the pros and cons.Stevens-Johnson syndrome, toxic epidermal necrolysis, large damage to the body, and its complications can be life there, Stevens-Johnson syndrome, toxic epidermal necrolysis, prognosis and the severity of the early close, to further reduce the disease on vision damage, the most important to prevent complications, to improve the prognosis of early skin lesions in the detailed examination of the eye is necessary, while taking into account their serious complications such as trichiasis, corneal epithelial disease and secondary infections, corneal epithelial angioplasty, eyelid suture, no preservatives, artificial tears and correct trichiasis may help to improve the prognosis of the syndrome.


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