Skip to main content
SpringerLink
Log in

Ocular Co-Morbidities of Atopic Dermatitis. Part I: Associated Ocular Diseases

  • Review Article
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Ocular diseases associated with atopic dermatitis (AD) may be sight-threatening. A general understanding of the pathophysiology, diagnosis, and treatment of atopic eye disease may assist dermatologists in knowing when to refer to ophthalmology and in co-managing these diseases with ophthalmologists. Ocular diseases associated with AD include eyelid dermatitis, keratoconjunctivitis, keratoconus, cataract, and retinal detachment. AD patients are also at higher risk for bacterial and viral ocular infections. The objective of this article is to provide a current review of ocular diseases that commonly affect AD patients. The pathogenesis, clinical manifestations, diagnosis, and treatment of ocular co-morbidities of AD will be discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Barbarot S, Auziere S, Gadkari A, Girolomoni G, Puig L, Simpson E, et al. Epidemiology of atopic dermatitis in adults: results from an international survey. Allergy. 2018;73(6):1284–93.

    Article  CAS  PubMed  Google Scholar 

  2. Spergel JM. Epidemiology of atopic dermatitis and atopic march in children. Immunol Allergy Clin N Am. 2010;30(3):269–80.

    Article  Google Scholar 

  3. Foster CS, Calonge M. Atopic keratoconjunctivitis. Ophthalmology. 1990;97(8):992–1000.

    Article  CAS  PubMed  Google Scholar 

  4. Thyssen JP, Toft PB, Halling-Overgaard AS, Gislason GH, Skov L, Egeberg A. Incidence, prevalence, and risk of selected ocular disease in adults with atopic dermatitis. J Am Acad Dermatol. 2017;77(2):280-6.e1.

    Article  Google Scholar 

  5. Boguniewicz M, Fonacier L, Guttman-Yassky E, Ong PY, Silverberg J, Farrar JR. Atopic dermatitis yardstick: Practical recommendations for an evolving therapeutic landscape. Ann Allergy Asthma Immunol. 2018;120(1):10–22.e2.

    Article  PubMed  Google Scholar 

  6. Schneider L, Tilles S, Lio P, Boguniewicz M, Beck L, LeBovidge J, et al. Atopic dermatitis: a practice parameter update 2012. J Allergy Clin Immunol. 2013;131(2):295-9.e27.

    Google Scholar 

  7. Bercovitch L. Screening for ocular complications in atopic dermatitis. Arch Dermatol. 2011;147(5):588–9.

    Article  PubMed  Google Scholar 

  8. Beck KM, Seitzman GD, Yang EJ, Sanchez IM, Liao W. Ocular co-morbidities of atopic dermatitis. Part II: ocular disease secondary to treatments. Am J Clin Dermatol. 2019. https://doi.org/10.1007/s40257-019-00465-3.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bielory B, Bielory L. Atopic dermatitis and keratoconjunctivitis. Immunol Allergy Clin N Am. 2010;30(3):323–36.

    Article  Google Scholar 

  10. Morgan DB. A suggestive sign of allergy. Arch Dermatol Syphilol. 1948;57(6):1050.

    Article  CAS  Google Scholar 

  11. Uehara M. Infraorbital fold in atopic dermatitis. Arch Dermatol. 1981;117(10):627–9.

    Article  CAS  PubMed  Google Scholar 

  12. Hanifin JM. Diagnostic features of atopic dermatitis. Acta Derm Venereol (Suppl). 1980;92:44–7.

    Google Scholar 

  13. Schram ME, Leeflang MM, Den Ottolander JP, Spuls PI, Bos JD. Validation and refinement of the Millennium criteria for atopic dermatitis. J Dermatol. 2011;38(9):850–8.

    PubMed  Google Scholar 

  14. Oka C, Ideta H, Nagasaki H, Watanabe K, Shinagawa K. Retinal detachment with atopic dermatitis similar to traumatic retinal detachment. Ophthalmology. 1994;101(6):1050–4.

    Article  CAS  PubMed  Google Scholar 

  15. Rich LF, Hanifin JM. Ocular complications of atopic dermatitis and other eczemas. Int Ophthalmol Clin. 1985;25(1):61–76.

    Article  CAS  PubMed  Google Scholar 

  16. Guglielmetti S, Dart JK, Calder V. Atopic keratoconjunctivitis and atopic dermatitis. Curr Opin Allergy Clin Immunol. 2010;10(5):478–85.

    Article  CAS  PubMed  Google Scholar 

  17. Hogan MJ. Atopic keratoconjunctivitis. Trans Am Ophthalmol Soc. 1952;50:265–81.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Dogru M, Nakagawa N, Tetsumoto K, Katakami C, Yamamoto M. Ocular surface disease in atopic dermatitis. Jpn J Ophthalmol. 1999;43(1):53–7.

    Article  CAS  PubMed  Google Scholar 

  19. Tuft SJ, Kemeny DM, Dart JK, Buckley RJ. Clinical features of atopic keratoconjunctivitis. Ophthalmology. 1991;98(2):150–8.

    Article  CAS  PubMed  Google Scholar 

  20. Bonini S. Atopic keratoconjunctivitis. Allergy. 2004;59(Suppl 78):71–3.

    Article  PubMed  Google Scholar 

  21. Sy H, Bielory L. Atopic keratoconjunctivitis. Allergy Asthma Proc. 2013;34(1):33–41.

    Article  CAS  PubMed  Google Scholar 

  22. Dart JK, Buckley RJ, Monnickendan M, Prasad J. Perennial allergic conjunctivitis: definition, clinical characteristics and prevalence. A comparison with seasonal allergic conjunctivitis. Trans Ophthalmol Soc UK. 1986;105(Pt 5):513–20.

    PubMed  Google Scholar 

  23. Tabbara KF. Ocular complications of vernal keratoconjunctivitis. Can J Ophthalmol (Journal canadien d’ophtalmologie). 1999;34(2):88–92.

    CAS  PubMed  Google Scholar 

  24. Kaujalgi R, Handa S, Jain A, Kanwar AJ. Ocular abnormalities in atopic dermatitis in Indian patients. Indian J Dermatol Venereol Leprol. 2009;75(2):148–51.

    Article  PubMed  Google Scholar 

  25. Leonardi A, Hall A. Mechanisms of corneal allergic reaction: new options for treatment. Expert Rev Ophthalmol. 2010;5(4):545–56.

    Article  Google Scholar 

  26. Chen JJ, Applebaum DS, Sun GS, Pflugfelder SC. Atopic keratoconjunctivitis: a review. J Am Acad Dermatol. 2014;70(3):569–75.

    Article  PubMed  Google Scholar 

  27. Hoang-Xuan T, Prisant O, Hannouche D, Robin H. Systemic cyclosporine A in severe atopic keratoconjunctivitis. Ophthalmology. 1997;104(8):1300–5.

    Article  CAS  PubMed  Google Scholar 

  28. Stumpf T, Luqmani N, Sumich P, Cook S, Tole D. Systemic tacrolimus in the treatment of severe atopic keratoconjunctivitis. Cornea. 2006;25(10):1147–9.

    Article  PubMed  Google Scholar 

  29. Wollenberg A, Ariens L, Thurau S, van Luijk C, Seegraber M, de Bruin-Weller M. Conjunctivitis occurring in atopic dermatitis patients treated with dupilumab: clinical characteristics and treatment. J Allergy Clin Immunol Pract. 2018;6(5):1778–80.e1.

    Article  PubMed  Google Scholar 

  30. Bawazeer AM, Hodge WG, Lorimer B. Atopy and keratoconus: a multivariate analysis. Br J Ophthalmol. 2000;84(8):834–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Harrison R, Klouda P, Easty D, Manku M, Charles J, Stewart C. Association between keratoconus and atopy. Br J Ophthalmol. 1989;73(10):816–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Galvis V, Sherwin T, Tello A, Merayo J, Barrera R, Acera A. Keratoconus: an inflammatory disorder? Eye (Lond). 2015;29(7):843–59.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Maharana PK, Dubey A, Jhanji V, Sharma N, Das S, Vajpayee RB. Management of advanced corneal ectasias. Br J Ophthalmol. 2016;100(1):34–40.

    Article  PubMed  Google Scholar 

  34. Nivenius E, Montan P. Spontaneous corneal perforation associated with atopic keratoconjunctivitis: a case series and literature review. Acta Ophthalmol. 2015;93(4):383–7.

    Article  PubMed  Google Scholar 

  35. Amano S, Inoue K. Clinic-based study on meibomian gland dysfunction in Japan. Investig Ophthalmol Vis Sci. 2017;58(2):1283–7.

    Article  Google Scholar 

  36. Hashemi H, Rastad H, Emamian MH, Fotouhi A. Meibomian gland dysfunction and its determinants in Iranian adults: a population-based study. Contact Lens Anterior Eye. 2017;40(4):213–6.

    Article  PubMed  Google Scholar 

  37. Wollenberg A, Wetzel S, Burgdorf WH, Haas J. Viral infections in atopic dermatitis: pathogenic aspects and clinical management. J Allergy Clin Immunol. 2003;112(4):667–74.

    Article  PubMed  Google Scholar 

  38. Wakamatsu TH, Dogru M, Ayako I, Takano Y, Matsumoto Y, Ibrahim OM, et al. Evaluation of lipid oxidative stress status and inflammation in atopic ocular surface disease. Mol Vis. 2010;16:2465–75.

    CAS  PubMed  PubMed Central  Google Scholar 

  39. Hu Y, Matsumoto Y, Dogru M, Okada N, Igarashi A, Fukagawa K, et al. The differences of tear function and ocular surface findings in patients with atopic keratoconjunctivitis and vernal keratoconjunctivitis. Allergy. 2007;62(8):917–25.

    Article  CAS  PubMed  Google Scholar 

  40. Bair B, Dodd J, Heidelberg K, Krach K. Cataracts in atopic dermatitis: a case presentation and review of the literature. Arch Dermatol. 2011;147(5):585–8.

    Article  PubMed  Google Scholar 

  41. Jeon HS, Choi M, Byun SJ, Hyon JY, Park KH, Park SJ. Association of pediatric atopic dermatitis and cataract development and surgery. JAMA Ophthalmol. 2018;136(8):912–8.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Andogsky N. Cataracta dermatogenes. Klin Mbl Augenh. 1914;52:824–31.

    Google Scholar 

  43. Cowan A, Klauder JV. Frequency of occurrence of cataract in atopic dermatitis. Arch Ophthalmol. 1950;43(4):759–68.

    Article  CAS  Google Scholar 

  44. Lee YB, Lee JH, Kang MJ, Choi JY, Kim JW, Yu DS, et al. Association between allergic diseases and ophthalmologic diseases, including cataracts and glaucoma, using the Korean National Health and Nutrition Examination Survey 2010–2012: a STROBE-compliant article. J Dermatol. 2018;45(4):463–7.

    Article  PubMed  Google Scholar 

  45. Taniguchi H, Ohki O, Yokozeki H, Katayama I, Tanaka A, Kiyosawa M, et al. Cataract and retinal detachment in patients with severe atopic dermatitis who were withdrawn from the use of topical corticosteroid. J Dermatol. 1999;26(10):658–65.

    Article  CAS  PubMed  Google Scholar 

  46. Niwa Y, Iizawa O. Abnormalities in serum lipids and leukocyte superoxide dismutase and associated cataract formation in patients with atopic dermatitis. Arch Dermatol. 1994;130(11):1387–92.

    Article  CAS  PubMed  Google Scholar 

  47. Carmi E, Defossez-Tribout C, Ganry O, Cene S, Tramier B, Milazzo S, et al. Ocular complications of atopic dermatitis in children. Acta Dermatovenereol. 2006;86(6):515–7.

    Google Scholar 

  48. Ayaki M, Ohoguro N, Azuma N, Majima Y, Yata K, Ibaraki N, et al. Detection of cytotoxic anti-LEDGF autoantibodies in atopic dermatitis. Autoimmunity. 2002;35(5):319–27.

    Article  CAS  PubMed  Google Scholar 

  49. Matsuo T, Saito H, Matsuo N. Cataract and aqueous flare levels in patients with atopic dermatitis. Am J Ophthalmol. 1997;124(1):36–9.

    Article  CAS  PubMed  Google Scholar 

  50. Matsuda A, Ebihara N, Kumagai N, Fukuda K, Ebe K, Hirano K, et al. Genetic polymorphisms in the promoter of the interferon gamma receptor 1 gene are associated with atopic cataracts. Investig Ophthalmol Vis Sci. 2007;48(2):583–9.

    Article  Google Scholar 

  51. Luo W, Xu W, Xia L, Xie D, Wang L, Guo Z, et al. Family-based whole exome sequencing of atopic dermatitis complicated with cataracts. Oncotarget. 2017;8(35):59446–54.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Garrity J, Liesegang T. Ocular complications of atopic dermatitis. Can J Ophthalmol (Journal canadien d’ophtalmologie). 1984;19(1):21–4.

    CAS  PubMed  Google Scholar 

  53. Amemiya T, Matsuda H, Uehara M. Ocular findings in atopic dermatitis with special reference to the clinical features of atopic cataract. Ophthalmologica. 1980;180(3):129–32.

    Article  CAS  PubMed  Google Scholar 

  54. Uchio E, Ono S, Ikezawa Z, Ohno S. Tear levels of interferon-, interleukin (IL)-2, IL-4 and IL-5 in patients with vernal keratoconjunctivitis, atopic keratoconjunctivitis and allergic conjunctivitis. Clin Exp Allergy. 2000;30(1):103–9.

    Article  CAS  PubMed  Google Scholar 

  55. Ohmachi N, Sasabe T, Kojima M, Adachi J, Endo K, Fukuzumi T, et al. Eye complications in atopic dermatitis. Arerugi. 1994;43(7):796–9.

    CAS  PubMed  Google Scholar 

  56. Nakano E, Iwasaki T, Osanai T, Yamamoto K, Miyauchi M. Ocular complications of atopic dermatitis. Nippon Ganka Gakkai Zasshi. 1997;101(1):64–8.

    CAS  PubMed  Google Scholar 

  57. Katsushima H, Miyazaki I, Sekine N, Nishio C, Matsuda M. Incidence of cataract and retinal detachment associated with atopic dermatitis. Nippon Ganka Gakkai Zasshi. 1994;98(5):495–500.

    CAS  PubMed  Google Scholar 

  58. Hida T, Tano Y, Okinami S, Ogino N, Inoue M. Multicenter retrospective study of retinal detachment associated with atopic dermatitis. Jpn J Ophthalmol. 2000;44(4):407–18.

    Article  CAS  PubMed  Google Scholar 

  59. Yoneda K, Okamoto H, Wada Y, Morita K, Takahashi M, Ogura Y, et al. Atopic retinal detachment. Report of four cases and a review of the literature. Br J Dermatol. 1995;133(4):586–91.

    Article  CAS  PubMed  Google Scholar 

  60. Sasoh M, Mizutani H, Matsubara H, Furuta M, Matsui Y, Yamanaka K, et al. Incidence of retinal detachment associated with atopic dermatitis in Japan: review of cases from 1992 to 2011. Clin Ophthalmol. 2015;9:1129–34.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Mitry D, Charteris DG, Fleck BW, Campbell H, Singh J. The epidemiology of rhegmatogenous retinal detachment: geographical variation and clinical associations. Br J Ophthalmol. 2010;94(6):678–84.

    Article  CAS  PubMed  Google Scholar 

  62. Wei CC, Kung YJ, Chen CS, Chang CY, Lin CJ, Tien PT, et al. Allergic conjunctivitis-induced retinal inflammation promotes myopia progression. Ebiomedicine. 2018;28:274–86.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Greenberg PB, Baumal CR. Laser therapy for rhegmatogenous retinal detachment. Curr Opin Ophthalmol. 2001;12(3):171–4.

    Article  CAS  PubMed  Google Scholar 

  64. Phulke S, Kaushik S, Kaur S, Pandav SS. Steroid-induced glaucoma: an avoidable irreversible blindness. J Curr Glaucoma Pract. 2017;11(2):67–72.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Takakuwa K, Hamanaka T, Mori K, Chin S, Shinmei Y, Funaki T, et al. Atopic glaucoma: clinical and pathophysiological analysis. J Glaucoma. 2015;24(9):662–8.

    Article  PubMed  Google Scholar 

  66. Kase S, Chin S, Hamanaka T, Shinmei Y, Ohguchi T, Kijima R, et al. Histological findings in the trabecular meshwork of a patient with atopic glaucoma. Open Ophthalmol J. 2017;11:103–6.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Sullivan M, Silverberg NB. Current and emerging concepts in atopic dermatitis pathogenesis. Clin Dermatol. 2017;35(4):349–53.

    Article  PubMed  Google Scholar 

  68. Ong PY, Ohtake T, Brandt C, Strickland I, Boguniewicz M, Ganz T, et al. Endogenous antimicrobial peptides and skin infections in atopic dermatitis. N Engl J Med. 2002;347(15):1151–60.

    Article  CAS  PubMed  Google Scholar 

  69. Nakata K, Inoue Y, Harada J, Maeda N, Watanabe H, Tano Y, et al. A high incidence of Staphylococcus aureus colonization in the external eyes of patients with atopic dermatitis. Ophthalmology. 2000;107(12):2167–71.

    Article  CAS  PubMed  Google Scholar 

  70. Huber-Spitzy V, Böhler-Sommeregger K, Arocker-Mettinger E, Grabner G. Ulcerative blepharitis in atopic patients: is Candida species the causative agent? Br J Ophthalmol. 1992;76(5):272–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Plattner KD, Tschopp M, Todorova MG. Skin ulceration of eyelids in atopic dermatitis. Klinische Monatsblätter für Augenheilkunde. 2018;235(04):445–7.

    Article  PubMed  Google Scholar 

  72. Borkar DS, Gonzales JA, Tham VM, Esterberg E, Vinoya AC, Parker JV, et al. Association between atopy and herpetic eye disease: results from the pacific ocular inflammation study. JAMA Ophthalmol. 2014;132(3):326–31.

    Article  PubMed  Google Scholar 

  73. Prabriputaloong T, Margolis TP, Lietman TM, Wong IG, Mather R, Gritz DC. Atopic disease and herpes simplex eye disease: a population-based case–control study. Am J Ophthalmol. 2006;142(5):745–9.

    Article  PubMed  Google Scholar 

  74. Popov Y, Nikolov R, Lalova A. Localized eczema herpeticum with unilateral ocular involvement. Acta dermatovenerologica Alpina, Pannonica, et Adriatica. 2010;19(3):35–7.

    CAS  PubMed  Google Scholar 

  75. Mackool BT, Goverman J, Nazarian RM. Case records of the Massachusetts General Hospital. Case 14-2012. A 43-year-old woman with fever and a generalized rash. N Engl J Med. 2012;366(19):1825–34.

    Article  CAS  PubMed  Google Scholar 

  76. Patel NN, Teng CC, Sperber LT, Dodick JM. New-onset herpes simplex virus keratitis after cataract surgery. Cornea. 2009;28(1):108–10.

    Article  PubMed  Google Scholar 

  77. Inoue Y. Ocular infections in patients with atopic dermatitis. Int Ophthalmol Clin. 2002;42(1):55–69.

    Article  PubMed  Google Scholar 

  78. Corey L, Wald A. Maternal and neonatal herpes simplex virus infections. N Engl J Med. 2009;361(14):1376–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Margolis TP, Ostler HB. Treatment of ocular disease in eczema herpeticum. Am J Ophthalmol. 1990;110(3):274–9.

    Article  CAS  PubMed  Google Scholar 

  80. Wilhelmus KR, Beck RW, Moke PS, Dawson CR, Barron BA, Jones DB, et al. Acyclovir for the prevention of recurrent herpes simplex virus eye disease. N Engl J Med. 1998;339(5):300–6.

    Article  Google Scholar 

  81. Amer R, Bamonte G, Forrester JV. Uveitis associated with immunoglobulin E-mediated allergic diseases. Clin Exp Ophthalmol. 2007;35(7):677–8.

    Article  PubMed  Google Scholar 

  82. Lim WK, Chee SP. Retinal detachment in atopic dermatitis can masquerade as acute panuveitis with rapidly progressive cataract. Retina. 2004;24(6):953–6.

    Article  PubMed  Google Scholar 

  83. Singh G, Mathur JS. Atopic erythroderma with bilateral cataract, unilateral keratoconus and iridocyclitis, and undescended testes. Br J Ophthalmol. 1968;52(1):61–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. Grajewski RS, Barahmand Pour N, Burian K, Caramoy A, Kirchhof B, Cursiefen C, et al. Analysis of the impact of allergy and atopy on new onset of uveitis. Acta Ophthalmol. 2017;95(3):e236–41.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA

    Kristen M. Beck, Eric J. Yang, Isabelle M. Sanchez & Wilson Liao

  2. Department of Ophthalmology, Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA

    Gerami D. Seitzman

Authors
  1. Kristen M. Beck
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gerami D. Seitzman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eric J. Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Isabelle M. Sanchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wilson Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kristen M. Beck.

Ethics declarations

Funding

No funding was received for this study.

Conflict of interest

Kristen M. Beck, Gerami D. Seitzman, Eric J. Yang, and Isabelle M. Sanchez have no conflicts of interest to declare. Wilson Liao has a research grant with Sanofi/Regeneron, which manufactures dupilumab. Sanofi/Regeneron was not involved in the content, writing, or review of this manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Beck, K.M., Seitzman, G.D., Yang, E.J. et al. Ocular Co-Morbidities of Atopic Dermatitis. Part I: Associated Ocular Diseases. Am J Clin Dermatol 20, 797–805 (2019). https://doi.org/10.1007/s40257-019-00455-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40257-019-00455-5

Search

Navigation