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Ophthalmologic Manifestations of Atopic Dermatitis Clinical Presentation

  • Author: R Scott Lowery, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Mar 13, 2014
 

History

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  • 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

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  • 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

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  • 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 Associate 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, American Association for Pediatric Ophthalmology and Strabismus, Arkansas Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department 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, Association for Research in Vision and Ophthalmology, American Glaucoma Society

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 Hospital

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, Allergan, Bausch & Lomb, Bio-Tissue, Shire, TearScience, TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue, TearScience.

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

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 Heart Association, American Association of Clinical Anatomists

Disclosure: Nothing to disclose.

References
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Typical atopic dermatitis on the face of an infant.
 
 
 
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