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]}

Treatment & Management

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Media Gallery

Typical atopic dermatitis on the face of an infant.

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Author

Sara Fard, MD Resident Physician, Department of Ophthalmology, University of Texas Health Science Center at San Antonio, Long School of Medicine

Sara Fard, MD is a member of the following medical societies: American Academy of Family Physicians, American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Coauthor(s)

Sehwa Nick Kang MD Candidate, University of Texas Health Science Center at San Antonio, Long School of Medicine

Disclosure: Nothing to disclose.

Constance L Fry, MD Professor, Department of Ophthalmology, UT Health San Antonio Long School of Medicine; Associate Preceptor, American Society of Ophthalmic Plastic Surgery, Oculofacial Fellowship, Medical Director, MARC Ophthalmology Clinic, Director, Ophthalmic Plastic Surgery and Ophthalmic Oncology, UT Health San Antonio

Constance L Fry, MD is a member of the following medical societies: Academy of Master Teachers, UTMB Health, American Academy of Ophthalmology, American Association of Ophthalmic Oncologists and Pathologists, American Society of Ophthalmic Plastic and Reconstructive Surgery, Research to Prevent Blindness, San Antonio Society of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Sidney Kimmel Medical College of Thomas Jefferson University; Director of the Cornea Service, 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, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: AAO; OMIC; American Society of Ophthalmic Trauma (ASOT); Avellino, Baxis; Bio-Tissue; Celularity; Dompe; Emmecell; Glaukos; Kala; Oyster Point; Sun Ophthalmics; Tarsus; TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Glaukos; Dompe; Bio-Tissue<br/>Received research grant from: Glaukos<br/>Received income in an amount equal to or greater than $250 from: AAO; OMIC; Baxis; Bio-Tissue; Cellularity; Dompe; Glaukos; Kala; Sun Ophthalmics; TearLab<br/>stock options for: RPS, Fount Bio.

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.

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.