Ophthalmologic Manifestations of Atopic Dermatitis Clinical Presentation

Updated: Sep 07, 2016
  • Author: R Scott Lowery, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Presentation

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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