Can Eye Drops Cause Steven Johnson Syndrome?

October 14, 2025 •

4 min read

Stevens-Johnson syndrome (SJS) is a rare but severe disorder, with an estimated annual incidence of 1.2 to 6.0 per million people [1.8.5]. While most cases are triggered by oral medications, the critical question remains for many: can eye drops cause Steven Johnson syndrome? The answer is yes, though it is exceptionally uncommon [1.2.1, 1.4.1].

Quick Summary

While rare, certain ophthalmic medications, particularly those containing sulfonamides like sulfacetamide and carbonic anhydrase inhibitors like dorzolamide, can trigger the severe and life-threatening skin reaction known as Stevens-Johnson syndrome (SJS) [1.5.1, 1.4.1].

Key Points

Yes, It's Possible: Though rare, topical ophthalmic medications (eye drops) can be absorbed systemically and trigger Stevens-Johnson syndrome (SJS) [1.2.1, 1.4.1].
High-Risk Drugs: Sulfonamide-based eye drops, such as sulfacetamide antibiotic drops and carbonic anhydrase inhibitors (dorzolamide, brinzolamide) for glaucoma, are the most frequently implicated [1.5.1, 1.6.2].
Systemic Reaction: The reaction is not localized to the eye; systemic absorption through the ocular mucous membranes causes a body-wide, life-threatening condition [1.4.1].
Medical Emergency: SJS starts with flu-like symptoms and progresses to a painful, blistering rash. It requires immediate discontinuation of the offending drug and emergency medical care [1.2.6].
Severe Ocular Damage: SJS itself frequently causes severe, long-term eye complications like chronic dry eye, scarring, and vision loss, regardless of the trigger [1.8.3, 1.4.6].
Genetic Predisposition: Certain genetic markers (HLA types) can increase the risk of SJS from specific drugs, including some eye drops, particularly in certain ethnic populations [1.4.4].

Understanding Stevens-Johnson Syndrome (SJS)

Stevens-Johnson syndrome (SJS) is a rare, severe, and potentially fatal hypersensitivity reaction that affects the skin and mucous membranes [1.8.2]. It is considered a medical emergency. SJS is characterized by a prodrome of flu-like symptoms, including fever and malaise, followed by the rapid onset of a painful red or purplish rash that spreads and blisters [1.2.6]. The top layer of the affected skin then dies and sheds [1.2.6]. When skin detachment affects less than 10% of the body surface area, it is classified as SJS. If it covers more than 30%, it is called toxic epidermal necrolysis (TEN), with the range of 10-30% being SJS/TEN overlap [1.8.2].

Medications are the leading trigger in over 80% of adult SJS cases [1.2.1, 1.8.2]. The reaction typically occurs within the first eight weeks of starting a new medication [1.2.1, 1.8.5]. While hundreds of drugs have been implicated, the most common offenders include certain antibiotics (especially sulfonamides), anti-gout medications like allopurinol, and anticonvulsants [1.9.1, 1.9.2].

The Link Between Eye Drops and SJS

Although the vast majority of medication-induced SJS cases are from systemic (oral or injected) drugs, topical medications, including eye drops, can also trigger this severe reaction [1.2.1]. Systemic absorption of the medication through the conjunctiva (the mucous membrane that covers the front of the eye and lines the inside of the eyelids) can be sufficient to initiate the body-wide hypersensitivity reaction [1.4.1]. Case reports have documented SJS and TEN developing after the use of ophthalmic preparations, proving that the route of administration does not preclude risk [1.2.1, 1.4.2]. A case has been documented where ophthalmic ofloxacin, an antibiotic, triggered severe SJS [1.2.1].

High-Risk Ophthalmic Medications

Certain classes of eye drops carry a higher known risk for inducing SJS, primarily due to their chemical structure.

Sulfonamide-Containing Eye Drops Sulfonamides ("sulfa drugs") are a well-established high-risk class for causing SJS [1.9.2]. This risk extends to ophthalmic preparations.

Sulfacetamide: This antibiotic eye drop, used to treat bacterial eye infections, has been explicitly linked to SJS in multiple case reports [1.5.1, 1.5.2]. The package insert for sulfacetamide eye drops includes a warning about the potential for rare but fatal hypersensitivity reactions, including SJS [1.5.5].

Carbonic Anhydrase Inhibitors (CAIs) This class of drugs is often used to lower intraocular pressure in glaucoma patients. Both systemic and topical CAIs, which are sulfonamide derivatives, have been associated with SJS/TEN [1.6.2].

Dorzolamide: This topical CAI is used in glaucoma treatment. There are documented cases of topical dorzolamide causing SJS and the more severe TEN [1.4.1, 1.4.2]. The risk may be higher in individuals with certain genetic predispositions, particularly those of Japanese or Korean descent with the HLA-B*5901 allele [1.4.4, 1.6.3].
Brinzolamide: Another topical CAI for glaucoma, brinzolamide has also been implicated in causing TEN [1.4.2, 1.6.2].

Comparison of Medication Risks for SJS


Feature	High-Risk Medications (Systemic)	Ophthalmic Medications (Topical)
Common Culprits	Allopurinol, Lamotrigine, Carbamazepine, Sulfamethoxazole [1.9.2, 1.9.4]	Sulfacetamide, Dorzolamide, Brinzolamide, Ofloxacin [1.5.1, 1.4.1, 1.6.2, 1.2.1]
Route of Exposure	Oral or Intravenous [1.2.1]	Topical (to the eye) [1.2.1]
Mechanism of Onset	Systemic circulation triggers a widespread immune response [1.3.2].	Systemic absorption through the mucous membranes of the eye [1.4.1].
Frequency	Responsible for the majority of drug-induced SJS cases (>80%) [1.8.2].	Very rare, documented primarily through case reports [1.2.1, 1.4.1].
Key Patient Factor	Prior drug reaction, certain HLA genetic markers (e.g., HLA-B*5801 for allopurinol) [1.3.2].	History of sulfa allergy, certain HLA genetic markers (e.g., HLA-B*5901 for CAIs) [1.4.4, 1.5.5].

Ocular Manifestations and Management of SJS

Ironically, the eyes are one of the most commonly and severely affected areas in SJS, regardless of the initial trigger [1.8.3]. Ocular involvement occurs in over 50% of patients [1.7.4].

Acute Symptoms:

Severe conjunctivitis (pink eye) with discharge [1.7.5]
Formation of pseudomembranes on the conjunctiva [1.7.4]
Eyelid edema and crusting [1.8.5]
Corneal blisters, erosions, or even perforation (holes) [1.7.3]
Extreme light sensitivity (photophobia) and pain [1.7.1]

Chronic Complications (Sequelae): Long-term damage can be devastating and includes:

Severe, chronic dry eye due to damage to tear-producing glands [1.4.6, 1.7.1]
Symblepharon (scar tissue that fuses the eyelid to the eyeball) [1.4.6]
Corneal scarring, vascularization, and opacification leading to vision loss [1.4.6]
In-turned eyelashes (trichiasis) that scratch the cornea [1.4.6]

Management of ocular SJS is intensive. In the acute phase, treatment focuses on lubrication, controlling inflammation with topical steroids, and using amniotic membrane grafts to promote healing and prevent scarring [1.7.2, 1.7.4]. Long-term care may involve specialized scleral contact lenses to protect the cornea and manage severe dry eye [1.7.5].

Conclusion

While exceedingly rare, it is unequivocally true that eye drops can cause Stevens-Johnson syndrome. The risk is highest with specific classes of drugs, notably sulfonamide antibiotics like sulfacetamide and carbonic anhydrase inhibitors like dorzolamide used for glaucoma [1.5.1, 1.4.1]. Although the probability is low, the severity of SJS is high, making it crucial for both clinicians and patients to be aware of this potential link. Any patient who develops a rash, fever, or mucous membrane sores within weeks of starting a new medication—including eye drops—should seek immediate medical attention [1.2.6].

For more information on SJS, consider visiting the Stevens-Johnson Syndrome Foundation.

Frequently Asked Questions

The most well-documented eye drops associated with SJS are sulfonamide-based medications. This includes sulfacetamide antibiotic eye drops and carbonic anhydrase inhibitors used for glaucoma, such as dorzolamide and brinzolamide [1.5.1, 1.4.1, 1.4.2].

It is extremely rare. The vast majority of SJS cases are caused by oral or injected medications. SJS from eye drops has been documented in medical literature primarily through individual case reports [1.2.1, 1.4.1].

Early symptoms are often non-specific and flu-like, such as fever, cough, sore eyes, and general malaise. This is typically followed by a painful red or purplish rash that spreads and blisters, and sores on mucous membranes like the mouth, nose, and genitals [1.2.1, 1.2.6].

Yes. If you have a known sulfonamide (sulfa) allergy, you should inform your doctor. They will likely avoid prescribing sulfonamide-containing eye drops, such as sulfacetamide or carbonic anhydrase inhibitors (dorzolamide, brinzolamide), as they can cause severe allergic reactions, including SJS [1.5.5, 1.6.2].

Yes. Case reports indicate that SJS triggered by the topical application of an ophthalmic medication can be just as severe and life-threatening as SJS caused by oral or parenteral (injected) drugs [1.2.1].

Drug-induced SJS typically develops within 8 weeks of starting the medication [1.2.1]. In one documented case involving ofloxacin eye drops, the reaction began within 24 hours [1.2.1].

The first and most critical step is to immediately stop using the suspected eye drop and seek emergency medical care. Treatment is largely supportive and focuses on managing symptoms, controlling infection, and providing wound care, often in a hospital's burn unit or intensive care unit [1.3.1, 1.7.4].