Chronic Ocular Complications in Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis: Clinical Features and Surgical Management in a Brazilian Tertiary Center

Purpose: To characterize the chronic ocular complications of Stevens–Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), focusing on culprit medications, long-term visual outcomes, and surgical interventions in a tertiary care population. Methods: This retrospective cross-sectional study was conducted at the Department of Ophthalmology, Federal University of São Paulo. Patients diagnosed with SJS or TEN in the chronic phase and followed for at least 12 months, between January 2012 and December 2024, were included. Clinical data, best-corrected visual acuity, ocular surface findings, implicated medications, and surgical interventions were analyzed. Results: A total of 112 patients were included (102 with SJS and 10 with TEN). Dipyrone (metamizole) was the most commonly implicated drug (38.4%), followed by penicillin (12.5%), phenobarbital (9.8%), phenytoin (8.0%), and sulfonamides (8.0%). The most prevalent chronic ocular findings were dry eye disease (97.3%), meibomian gland dysfunction (98.2%), limbal stem cell deficiency (78.6%), trichiasis (64.3%), symblepharon (60.7%), conjunctival keratinization (55.3%), and corneal keratinization (24.1%). Visual acuity was often severely impaired. Most patients required surgical interventions (88.4%), including mucous membrane grafts, limbal stem cell transplantation, salivary gland transplantation, penetrating keratoplasty, and keratoprosthesis implantation. Conclusions: Our findings highlight the significant burden of severe ocular surface disease, the predominance of dipyrone as a causative drug in this population, and the need for complex surgical interventions in a significant proportion of cases. These results underscore the importance of early management of ocular complications, long-term follow-up, and access to advanced therapeutic strategies.