Ophthalmologic Manifestations of Atopic Dermatitis Clinical Presentation
- Author: R Scott Lowery, MD; Chief Editor: Hampton Roy, Sr, MD more...
See the list below:
- 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.
See the list below:
- 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.
See the list below:
- 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.
Rapoza PA, Chandler JW. Atopic dermatitis. Weingeist T, Gould D, eds. The Eye in Systemic Disease. Philadelphia: Lippincott; 1990. 606-609.
Shen CP, Xing H, Ma L. [Research advances in atopic dermatitis]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2009 Feb. 31(1):103-6. [Medline].
Jung T, Stingl G. Atopic dermatitis: therapeutic concepts evolving from new pathophysiologic insights. J Allergy Clin Immunol. 2008 Dec. 122(6):1074-81. [Medline].
Bezan DJ. Eye itch. Bezan DJ, Larussa FP, Nishimoto JH, et al, eds. Differential Diagnosis in Primary Eye Care. Boston: Butterworth-Heinemann; 1999. 67-71.
Brenninkmeijer EE, Legierse CM, Sillevis Smitt JH, Last BF, Grootenhuis MA, Bos JD. The course of life of patients with childhood atopic dermatitis. Pediatr Dermatol. 2009 Jan-Feb. 26(1):14-22. [Medline].
Bielory B, Bielory L. Atopic dermatitis and keratoconjunctivitis. Immunol Allergy Clin North Am. 2010 Aug. 30(3):323-36. [Medline].
Cornish KS, Gregory ME, Ramaesh K. Systemic cyclosporin A in severe atopic keratoconjunctivitis. Eur J Ophthalmol. 2010 Sep-Oct. 20(5):844-51. [Medline].
Anderson PC, Dinulos JG. Atopic dermatitis and alternative management strategies. Curr Opin Pediatr. 2009 Feb. 21(1):131-8. [Medline].
Ricci G, Dondi A, Patrizi A, Masi M. Systemic therapy of atopic dermatitis in children. Drugs. 2009. 69(3):297-306. [Medline].
Kaujalgi R, Handa S, Jain A, Kanwar AJ. Ocular abnormalities in atopic dermatitis in Indian patients. Indian J Dermatol Venereol Leprol. 2009 Mar-Apr. 75(2):148-51. [Medline].
Clark RAF, Kristal L. Atopic dermatitis. Sams J, Lynch PJ, eds. Principles and Practice of Dermatology. 2nd ed. New York: Churchill Livingstone Inc; 1996. 403-418.
Friedlander MH. Diseases affecting the eye and the skin. Allergy and Immunology of the Eye. 2nd ed. 1993. 75-106.
Friedlander MH. Atopic dermatitis. Current Ocular Therapy. 5th ed. Philadelphia: WB Saunders Co; 2000. 143-144.
Furue M, Terao H, Moroi Y, et al. Dosage and adverse effects of topical tacrolimus and steroids in daily management of atopic dermatitis. J Dermatol. 2004 Apr. 31(4):277-83. [Medline].
Guin JD. Eyelid dermatitis: experience in 203 cases. J Am Acad Dermatol. 2002 Nov. 47(5):755-65. [Medline].
Hanifin JM. Atopic dermatitis: broadening the perspective. J Am Acad Dermatol. 2004 Jul. 51(1 Suppl):S23-4. [Medline].
Kanski JJ. Disorders of the conjunctiva. Clinical Ophthalmology. 4th ed. Boston: Butterworth-Heinemann; 1999. 69-71.
Liesegang TJ. Atopic keratoconjunctivitis. Pepose JS, Holland GN, Wilhelmus KR, eds. Ocular Infection and Immunity. St. Louis: Mosby; 1996. 376-390.
Roy FH. Ocular Differential Diagnosis. 7th ed. Philadelphia: Williams & Wilkins; 2002.
Shelley WB, Shelley EB. Atopic dermatitis. Advanced Dermatologic Diagnosis. Philadelphia: WB Saunders Co; 1992. 285-291.
Uchio E, Miyakawa K, Ikezawa Z, Ohno S. Systemic and local immunological features of atopic dermatitis patients with ocular complications. Br J Ophthalmol. 1998 Jan. 82(1):82-7. [Medline].
Weisbecker CA, Fraunfelder FT, Rhee D. Physicians' Desk Reference for Ophthalmology. 28th ed. Oradell, NJ: Medical Economics Co; 2000.
Zimmerman TJ, Kulkarni PS, Meredith TA. Steroids in ocular therapy, antibiotics and antifungals, antiallergic therapies. Zimmerman TJ, Kooner KS, Shariv M, Fechtner RD, eds. Textbook of Ocular Pharmacology. Philadelphia: Lippincott-Raven; 1997. 61-74, 363-385, 609-633,683-701, 801-804.