Translate this page into:
Role of bedside eyelash trimming in preventing corneal sequelae in acute Stevens–Johnson syndrome/toxic epidermal necrolysis
-
Received: ,
Accepted: ,
How to cite this article: Bisoyi D, Singh A, Gagarai A. Role of bedside eyelash trimming in preventing corneal sequelae in acute Stevens– Johnson syndrome/toxic epidermal necrolysis. CosmoDerma. 2026;6:67. doi: 10.25259/CSDM_48_2026
PROBLEM
One important ocular complication in Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) is trichiasis, in which misdirected eyelashes rub against the corneal surface.[1] This constant friction can result in corneal epithelial defects, ulceration, persistent inflammation, neovascularization, and potentially vision-threatening outcomes such as scarring or perforation.[2] During the acute phase of SJS–TEN, eyelid edema and mucosal fragility can worsen trichiasis, making prompt management essential to prevent irreversible corneal damage.[3] Conventional management includes intensive lubrication, tarsorrhaphy, surgical correction, or amniotic membrane transplantation.[4] However, such interventions may not always be readily available in resource-limited settings. A 28-year-old woman presented to the dermatology department with a 2-day history of severe skin peeling. On examination, she had erythematous macules and patches over the skin with areas of peeling and raw, necrotic skin, involving around 20–30% of her body surface area. There was also significant involvement of the mucosal surfaces, including the eyes, mouth, and genital region. Her eyes showed bilateral trichiasis with matted eyelashes [Figure 1]. Based on these clinical findings, a diagnosis of SJS-TEN overlap was made, with a SCORTEN score of 3, indicating moderate severity. Further assessment using the World Health Organization criteria and the Naranjo algorithm suggested that ofloxacin was the probable cause of this reaction. The patient was treated with systemic corticosteroids (injectable dexamethasone) along with supportive therapy. In this situation, we used a simple bedside eyelash-trimming technique as an immediate and practical measure to reduce corneal irritation and help prevent further ocular complications.
SOLUTION
Step 1: Under aseptic precautions, the eyelids were gently everted. Step 2: The eye was supported with gauze placed below the eyelid. Step 3: Misdirected eyelashes were carefully trimmed using sterile curved scissors [Figure 2]. Step 4: After the procedure, a petroleum-based lubricant ointment was applied using a cotton-tipped applicator. The patient was advised to use artificial tears along with regular eyelid hygiene. At the 48-h follow-up, the corneal abrasions had healed, and ocular inflammation had noticeably improved [Figure 3]. During follow-up, the patient showed progressive regrowth of eyelashes. By day 25, the eyelashes appeared well developed, with further improvement noted by day 45 after trimming without any complication [Figure 4a and b]. This simple bedside eyelash-trimming approach provided quick relief and helped control acute trichiasis in SJS-TEN, thereby protecting the cornea during the acute stage of the illness. Although straightforward, this practical intervention may be particularly useful in hospital settings, and further studies are needed to establish its effectiveness better.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for their images and other clinical information to be reported in the journal. The patient understands that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
References
- Severe ocular complications of SJS/TEN and associations among pre-onset, acute, and chronic factors: A report from the international ophthalmology collaborative group. Front Med (Lausanne). 2023;10:1189140.
- [CrossRef] [PubMed] [Google Scholar]
- Updates on the ocular manifestations and treatment of SJS/TEN. Allergol Int. 2025;74:356-60.
- [CrossRef] [PubMed] [Google Scholar]
- Acute and chronic ophthalmic involvement, severity, and sequelae in stevens-johnson syndrome and toxic epidermal necrolysis. Korean J Ophthalmol. 2021;35:179-87.
- [CrossRef] [PubMed] [Google Scholar]
- Management of ocular involvement in the acute phase of Stevens-Johnson syndrome and Toxic epidermal necrolysis: French national audit of practices, literature review, and consensus agreement. Orphanet J Rare Dis. 2020;15:259.
- [CrossRef] [PubMed] [Google Scholar]