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Ophthalmologic Manifestations of Atopic Dermatitis Medication

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

Medication Summary

The most commonly used treatment strategies include antibiotics, corticosteroids, antihistamines, and, less commonly, immunosuppressives (other than steroids), UV light, and hospitalization (rare). For most cases of atopic dermatitis (without AKC), application of topical steroids to the affected area is usually sufficient. Eye involvement may be treated with topical steroids alone, or if symptoms persist, additional mast cell stabilizers (topical), and oral antihistamines (eg, over-the-counter diphenhydramine). AKC may require all of these, and some ophthalmologists recommend that an oral antibiotic be given in addition to a topical antibiotic for the affected eye(s). Antibiotic treatment should target S aureus, the most likely pathogen, and should be chosen based on the patient's allergies and compliance. Immunosuppressives, other than steroids, will only very rarely be required, and these likely will not be prescribed by the ophthalmologist.



Class Summary

As anti-inflammatory and immunosuppressive agents, corticosteroids are beneficial in treating atopic dermatitis. Dexamethasone, fluorometholone, hydrocortisone, and prednisolone are the most commonly available preparations of ophthalmic steroids in the United States. Preparations range from 0.05-2.5%. For most topical purposes, a 0.5% preparation of prednisolone, cortisone, or hydrocortisone is adequate.

Prednisolone ophthalmic


Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.


Mast cell stabilizers

Class Summary

May be useful as prophylaxis against exacerbation of the disease.

Lodoxamide (Alomide)


Inhibits degranulation of mast cells and helps prevent histamine release.

Cromolyn (Crolom, Opticrom)


Inhibits degranulation of sensitized mast cells following exposure to specific antigens.


Oral antihistamines

Class Summary

Useful in decreasing itching and scratching associated with atopic dermatitis.

Hydroxyzine (Atarax, Vistaril, Vistazine)


Antagonizes H1 receptors in periphery; may suppress histamine activity in subcortical region of CNS; may assist in sleep.


Topical antibiotics

Class Summary

Atopic conjunctivitis requires the use of topical antibiotics that particularly target S aureus, the most common pathogen. Since most ophthalmic antibiotics will target this bacterium, physician discretion, reference to package inserts, and the ophthalmic Physicians' Desk Reference are recommended. Patients' allergies and compliance should be considered.

Gatifloxacin ophthalmic (Zymar)


Fluoroquinolone with activity against streptococci, staphylococci, Corynebacterium propinquum, and Haemophilus influenzae; inhibits bacterial DNA synthesis and, consequently, growth.

Contributor Information and Disclosures

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.

  1. Rapoza PA, Chandler JW. Atopic dermatitis. Weingeist T, Gould D, eds. The Eye in Systemic Disease. Philadelphia: Lippincott; 1990. 606-609.

  2. 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].

  3. Jung T, Stingl G. Atopic dermatitis: therapeutic concepts evolving from new pathophysiologic insights. J Allergy Clin Immunol. 2008 Dec. 122(6):1074-81. [Medline].

  4. 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.

  5. 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].

  6. Bielory B, Bielory L. Atopic dermatitis and keratoconjunctivitis. Immunol Allergy Clin North Am. 2010 Aug. 30(3):323-36. [Medline].

  7. Cornish KS, Gregory ME, Ramaesh K. Systemic cyclosporin A in severe atopic keratoconjunctivitis. Eur J Ophthalmol. 2010 Sep-Oct. 20(5):844-51. [Medline].

  8. Anderson PC, Dinulos JG. Atopic dermatitis and alternative management strategies. Curr Opin Pediatr. 2009 Feb. 21(1):131-8. [Medline].

  9. Ricci G, Dondi A, Patrizi A, Masi M. Systemic therapy of atopic dermatitis in children. Drugs. 2009. 69(3):297-306. [Medline].

  10. 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].

  11. 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.

  12. Friedlander MH. Diseases affecting the eye and the skin. Allergy and Immunology of the Eye. 2nd ed. 1993. 75-106.

  13. Friedlander MH. Atopic dermatitis. Current Ocular Therapy. 5th ed. Philadelphia: WB Saunders Co; 2000. 143-144.

  14. 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].

  15. Guin JD. Eyelid dermatitis: experience in 203 cases. J Am Acad Dermatol. 2002 Nov. 47(5):755-65. [Medline].

  16. Hanifin JM. Atopic dermatitis: broadening the perspective. J Am Acad Dermatol. 2004 Jul. 51(1 Suppl):S23-4. [Medline].

  17. Kanski JJ. Disorders of the conjunctiva. Clinical Ophthalmology. 4th ed. Boston: Butterworth-Heinemann; 1999. 69-71.

  18. Liesegang TJ. Atopic keratoconjunctivitis. Pepose JS, Holland GN, Wilhelmus KR, eds. Ocular Infection and Immunity. St. Louis: Mosby; 1996. 376-390.

  19. Roy FH. Ocular Differential Diagnosis. 7th ed. Philadelphia: Williams & Wilkins; 2002.

  20. Shelley WB, Shelley EB. Atopic dermatitis. Advanced Dermatologic Diagnosis. Philadelphia: WB Saunders Co; 1992. 285-291.

  21. 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].

  22. Weisbecker CA, Fraunfelder FT, Rhee D. Physicians' Desk Reference for Ophthalmology. 28th ed. Oradell, NJ: Medical Economics Co; 2000.

  23. 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.

Typical atopic dermatitis on the face of an infant.
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