Ocular manifestations in Stevens‒Johnson syndrome/toxic epidermal necrolysis in cancer patients

Purpose: To evaluate the characteristics, risk factors, and outcomes of ocular involvement in cancer patients with Stevens‒Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), focusing on the role of immune checkpoint inhibitors (ICIs). Methods: This retrospective case‒control study was conducted at Chang Gung Memorial Hospital, Linkou, Taiwan, between 2004 and 2024. A total of 112 patients with confirmed SJS/TEN and concurrent malignancies were included. The primary outcomes were the prevalence and severity of acute and chronic ocular involvement, assessed using Sotozono's classification. Risk factors for ocular involvement were investigated through univariate and multivariate logistic regression. Results: Of 112 patients, 46 (41.1 %) developed ocular complications. TEN (adjusted OR, 3.11; 95 % CI, 1.24–7.78; P = 0.02), systemic mucosal involvement (adjusted OR, 4.89; 95 % CI, 1.52–15.80; P = 0.01), and polypharmacy (adjusted OR, 3.52; 95 % CI, 1.36–9.11; P = 0.01) were significant risk factors for ocular involvement. ICI-related SJS/TEN exhibited longer latency (31.0 vs. 13.4 days; P < 0.001) and delayed healing (72.3 vs. 45.8 days; P = 0.002). Chronic ocular complications were more severe in surviving ICI-related patients, as indicated by significantly higher chronic Sotozono scores (7.5 vs. 3.7; P = 0.001), worse dry eye (Schirmer's test 1.8 vs. 3.4 mm; P = 0.01), and poorer visual recovery (0.11 vs. 0.43 logMAR; P = 0.001). Conclusions: SJS/TEN in cancer patients, particularly those receiving ICIs, is associated with substantial ocular morbidity. The increasing prevalence of ICI-related SJS/TEN emphasizes the need for vigilant ophthalmologic intervention and long-term monitoring.