Autologous simple limbal epithelial transplantation for unilateral total limbal stem cell deficiency in Stevens–Johnson syndrome sequelae

Stevens–Johnson syndrome (SJS) typically causes bilateral ocular surface disease, and unilateral total limbal stem cell deficiency (LSCD) is uncommon. We report a 53-year-old female with chronic SJS sequelae presenting with unilateral total LSCD and asymmetrical involvement. Initial management included lid margin mucous membrane grafting (MMG) to address keratinization and ocular surface inflammation. After surface stabilization, autologous simple limbal epithelial transplantation (SLET) with symblepharon lysis and conjunctival autografting was performed. Postoperatively, the patient showed significant symptomatic relief and stable corneal epithelialization, with improvement in best corrected visual acuity from hand movements to 20/200 over six months. The ocular surface remained stable, and the contralateral eye showed no disease progression. This case highlights the rare presentation of unilateral LSCD in SJS and emphasizes the importance of a staged approach, addressing lid margin pathology prior to ocular surface reconstruction. Autologous SLET can achieve favorable anatomical and functional outcomes in carefully selected cases.