Ophthalmologic Manifestations of Atopic Dermatitis Workup

Updated: Jun 07, 2022
  • Author: Sara Fard, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Approach Considerations

Diagnosis of AD and its associated ophthalmologic complications are clinical diagnoses based on history and physical exam findings (with details in the "Presentation" tab). A family history of atopic disease (including asthma, allergic rhinitis and/or AD) is usually present. [33] Laboratory studies, cultures and histopathologic analyses to aid in diagnosis are described below. 


Laboratory Studies

Laboratory tests that may aid in diagnosis of AD and its ophthalmologic manifestations, especially in the early clinical stages, include various types of skin testing and serum testing for elevated immunoglobulin E (IgE). IgE levels in tears have also been shown to correlate with clinical severity of atopic eye disease including AKC. [1, 2, 33]

Patients with atopic dermatitis display immediate skin test reactivity and may display skin blanching to cholinergic agents. [2]

Culture of eyes with conjunctivitis associated with atopic dermatitis usually grows Staphylococcus aureus. Brush cytology, a process that involves taking superficial scrapings from the tarsal conjunctiva, has been used to quantify levels of inflammatory cells, including eosinophils and neutrophils, and has been correlated to disease severity. [2, 33]

Once a clinical diagnosis of atopic dermatitis has been established, lab testing is generally unnecessary. [2]



Histologic Findings

Skin and conjunctival biopsy is rarely used to diagnose AD and ophthalmologic complications including AKC. Examination of histopathologic sections early in the disease process show parakeratosis, hyperkeratosis, acanthosis, intercellular and intracellular fluid accumulation, and perivascular infiltration of the dermis and epidermis by lymphocytes, monocytes, and macrophages. [34] Later in the disease, observation reveals hyperkeratosis, dyskeratosis, acanthosis, and a thickened epidermis. [34] Lysosomes have been demonstrated by electron microscopy. [34] Conjunctival biopsy shows mast cell and inflammatory cell (eg, eosinophils and neutrophils) infiltration of the conjunctival epithelium. [3, 33]