The patient, a 50-year-old housewife, presented with gradual dimness of vision and dryness in both eyes for 3 years. She had a history of drug-induced bullous lesions during treatment for typhoid fever 3 years ago. On examination, her vision was 6/60 in both eyes with thickened eyelids, trichiasis, dry conjunctiva with shortening of the fornices, and corneal opacity in both eyes. The diagnosis was ocular surface disorder due to Stevens-Johnson Syndrome resulting from her previous drug reaction.

1. Dr. Md. Rezwanul Hasan
DO Student
Rangpur Medical College Hospital Rangpur

2. Particulars of Patient
 Name : Mrs. Ashia
 Age : 50 yrs
 Sex : Female
 Occupation : Housewife
 Marital status : Married
 Address : Johurdanga, Sadar Thana, Rangpur
 Date Of Admission : 21.01.17
 Date Of Examination : 25.01.17

3. Chief Complaints
 Gradual Dimness of vision for 3 yrs
 Dryness and foreign body sensation for same
duration.

4. History of present illness
 According to the statement of the patient, she was
resonabley well 3 yrs back. Then she got typhoid fever
and after starting medication she got bullous leisions
all over her body.
 Following recovery of typhoid fever, she suffered in
gradual dimness of vision.
 She also complaints dryness and foreign body
sensation in her both eyes.
 She gives no history of diplopia.

5. Cont…
 With these complaints she consulted with near by
ophthalmologist several times.
 She was referred to Rangpur Medical College
Hospital for better management.

6. Past Ocular History
 No history of trauma.
 No history of use of spectacles.

7. Medical and surgical history
 Medical - She suffered in typhoid fever 3 yrs back and
treated accordingly.
 Surgical – No surgical history

8. Family History
 No other family members are suffering from any ocular
or systemic disease related to present complaint

9. Drug History
 She gave history of drug reaction during treatment of
typhoid fever 3yrs back.
 She was treated by severals drugs for present
complaint but cann’t mention the names.

10. Review of other systems
 Respiratory system, cardiac system, Nervous system,
Genitourinary system, Gastrointestinal system and
other systems reveals no other abnormality.

11. General Examination
 Appearance – Ill looking
 Anemia
 Jaundice Absent
 Cyanosis
 Patient – Cooperative
 Lymph node – not palpable
 Pulse – 76/min
 BP – 110/70 mmHg

12. Ocular Examination
 VISUAL ACUITY
 R/E : unaided – 6/60
pinhole – 6/36
not improved with refraction
 L/E : unaided – 6/60
pinhole – not improved
not improved with refraction
 Color vision – Trichromatic both eye
 Field of vision – Normal in Rt eye
Mild restriction in nasal field in Lt eye

13. External Examination
 Inspection
1. Head posture - normal
2. Symmetry of the face - normal
3. Eye brow & fore head - normal
4. Eye lids – Thickened
5. Palpebral fissure - Narrow
6. Position of the eyeball - Normal
 Hirschberg’s light reflex – Central in both eyes
 Ocular motility – Mildly reduced in medial gaze in Lt. eye
 Pupil – size: 4mm in normal room light

14. Slit Lamp Examination
Right Eye Left Eye
Eyelids Thickened Thickened
Eye Lashes Trichiasis and Distichiasis Trichiasis and Distichiasis
Conjunctiva Dry and lusterless,
Shortening of upper and
lower fornices due to
adhesion between bulbar
and palpebral conjunctiva
Dry and lusterless,
Shortening of upper and
lower fornices due to
adhesion between bulbar
and palpebral conjunctiva
Cornea Opacity and
vascularization present in
all around the limbus
Opacity and
vascularization present in
all around the limbus
A/C Normal in depth and
content
Normal in depth and
content
Iris Normal Normal
Pupil Center, circular, brisk Center, circular, brisk

15. Ophthalmoscopy
 Could not done due to hazy media.

16. Salient Feature
 The patient Mrs. Ashia, 50yrs old housewife
hailing from Johurdanga, Sadar Thana, Rangpur, got
admitted in Rangpur Medical College, Hospital on
21.01.2017 with the complaints of gradual dimness of
vision, foreign body sensation and dryness for 3yrs.
She gave history of drug induced allergic reaction
during medication for typhoid fever 3yrs back which
involved eruption of bullous leisions all over her body.
She is non diabetic, non hypertensive and other
systemic examinations reveals no abnormality.

17. Cont…
 On ocular examination her V/A Rt eye 6/60 with P/H
6/36, Lt eye 6/60 with P/H not improved. Mildly
reduced ocular motility in medial gaze in Lt eye with
restricted nasal field of vision in same eye. Rt eye is
normal.
 On slitlamp examination, eyelids are thickened,
trichiasis and distichiasis present in both eyes.
Conjunctiva dry and lusterless with shortening of
upper and lower fornices due to adhesion between
bulbar and palpebral conjunctiva by fibrous band in
both eyes.

18. Cont…
 Opacity and vascularization present in all around the
limbuses of both corneas. A/C is normal in depth and
content. Lenses are mildly opaque in both eyes.
Posterior segment could not be visualized due to hazy
media.

19. So…
 My diagnosis is ocular surface disorder due to Stevens-
Johnson Syndrome.

20. THANK YOU ALL