Ophthalmologic Manifestations of Atopic Dermatitis Clinical Presentation

  • Author: R Scott Lowery, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 14, 2012
 

History

  • The most common symptoms include pruritus, erythema, and skin lesions of the antecubital and/or popliteal skin, eyelids, corners of the mouth, neck, outer canthi, or behind the ears.
  • In infants, the eruption particularly involves the face, scalp, and extensor surfaces.
  • In older children and adults, the neck and antecubital or popliteal areas more commonly are involved.
  • Adult patients usually have a history of infantile disease that may require anecdotal history or contacting their caregivers from infancy.
  • Most patients have a familial occurrence of symptoms of atopy.
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Physical

  • The most common physical findings are erythematous, exudative skin lesions of the antecubital and/or popliteal skin, eyelids, corners of the mouth, neck, outer canthi, or behind the ears.
    • Scaling, lichenification (thickening of the skin due to scratching and irritation), and pigmentary changes (eg, vitiligo, hyperpigmentation [often seen in patients with darker skin types]) are common in adolescents and adults.
    • In severe cases, generalized eruptions over the entire body may occur.
  • Possible physical findings on slit lamp examination include blepharitis, atopic keratoconjunctivitis (AKC),[6, 7] scarring of the palpebral conjunctiva, papillary conjunctival reaction, Trantas dots (limbal deposits of eosinophils), atopic cataracts, and keratoconus.
    • Unlike vernal conjunctivitis, the lower tarsus is involved more frequently.
    • Hyperemia, chemosis, and discharge are more common than papillary or cobblestone reaction.
  • Atopic cataracts develop in patients with long-standing atopic disease (10 or more years).
    • These patients usually are older children or young adults.
    • The incidence of atopic cataracts is estimated to be 10%, and they are most frequently bilateral.
    • These cataracts tend to evolve rapidly and may opacify within 6 months.
    • The cataracts often begin as a posterior subcapsular opacity and develop into an anterior cortex opacity that frequently resembles the shape of a shield or a bearskin rug.
  • Spontaneous retinal detachment is more common in patients with atopic disease than the general population.
  • In a few rare, advanced cases, symblepharon, entropion, and trichiasis may be seen.
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Causes

  • Abnormal skin reactivity is a feature of the disease, and exposure to skin irritants, most frequently water and chemicals, may predispose patients to the development of atopic dermatitis.
  • Additionally, since many of these patients have allergic sensitivities to food or inhaled allergens, exposure to these may increase the chances of development of the dermatitis.
  • Skin irritants, thought to trigger this more frequently than other allergens, also may be more readily avoidable.
  • Psychological stress has been implicated as a possible contributor to disease development.
  • Recent studies have implicated loss-of-function mutations in the barrier protein filaggrin and diminished expression of certain antimicrobial peptides in atopic dermatitis skin, which may lead to further treatment research.
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Contributor Information and Disclosures
Author

R Scott Lowery, MD  Assistant Professor of Ophthalmology, Department of Pediatric Ophthalmology and Strabismus, University of Arkansas for Medical Sciences College of Medicine, Arkansas Children's Hospital

R Scott Lowery, MD is a member of the following medical societies: American Academy of Ophthalmology and Arkansas Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Jack L Wilson, PhD  Distinguished Professor, Department of Anatomy and Neurobiology, University of Tennessee Health Science Center College of Medicine

Jack L Wilson, PhD is a member of the following medical societies: American Association of Anatomists, American Association of Clinical Anatomists, and American Heart Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; RPS Ownership interest Other; EyeGate Pharma Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting; Merck Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

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