Dermatologist management of ocular surface diseases in patients with atopic dermatitis

Original Article: Practical Management of Ocular Surface Disease in Patients with Atopic Dermatitis, with a Focus on Conjunctivitis: A Review

What are the key takeaways of this article?

Atopic dermatitis (AD), also known as eczema, is a chronic inflammatory disease of the skin associated with decreased quality of life. Internationally, AD affects up to 20% of children and 3% of adults. AD is associated with several comorbidities, including allergic rhinitis, asthma, food allergies, ichthyosis vulgaris, psychiatric disorders, metabolic syndromes, cardiovascular disease, and ocular surface diseases (OSDs). In fact, up to 90% of patients with AD may suffer from OSD. However, while OSD is an important comorbidity of AD, it is estimated to be highly underreported. This review paper, written in collaboration between dermatologists and ophthalmologists, explores OSD in patients with AD, and provides treatment and referral recommendations.

AD associated OSDs include keratoconjunctivitis sicca, blepharitis, keratoconus, corneal inflammation, and conjunctivitis. The most common OSD is conjunctivitis with the most prevalent subtype being allergic conjunctivitis. Nevertheless, other conjunctivitis subtypes (papillary, vernal, atopic, and infectious), are also associated with AD.

Risk factors for comorbid OSD include higher AD severity, comorbid asthma bronchiale and rhinitis, and childhood onset of AD. Genetic history of atopy (a genetic predisposition to overactive IgE-mediated immune reaction), facial involvement of AD, and age also influence OSD development. The use of monoclonal antibody biologics, a treatment used for moderate-to-severe AD, may be associated with increased incidence of conjunctivitis.

There are several measures that can be taken by healthcare providers to provide better care for AD patients. Dermatologists can screen AD patients for common, easily recognizable signs and symptoms of OSDs, including eye redness, periocular dermatitis, discharge, photophobia, pruritus, vision changes, and pain/discomfort in the eyes. Dermatologists should also be mindful of screening all patients starting or continuing monoclonal antibody biologics. Screening is important for both detection and treatment. Mild signs and symptoms of OSD can be managed by dermatologists, including hyperemia, mild mucous discharge, pruritus, and mild conjunctival swelling. Dermatologists are recommended to refer patients to ophthalmology in more severe cases of OSD, such as in cases of conjunctival scarring or swelling, pain, watery discharge, blepharitis, dryness, irritation, or photophobia. Urgent referral is required for vision changes, purulent discharge, eyelid swelling where preseptal cellulitis is suspected, or loss of corneal clarity. Baseline evaluation of patients considering monoclonal antibody biologics may be beneficial. Overall, the key takeaways of this research include: dermatologists should screen for OSDs in patients with AD; dermatologists may manage some OSDs; referral from dermatology to ophthalmology is important, and further details on the guidelines for referral are outlined in the original article.

Publication Date: August 13th, 2023

Reference: Vivian Y. Shi, Winston Chamberlain, Elaine Siegfried, Cheryl Kraff-Cooper, Kenneth Beckman, Peter Lio, Amy S. Paller, Eric Simpson, Practical management of ocular surface disease in patients with atopic dermatitis, with a focus on conjunctivitis: A review, Journal of the American Academy of Dermatology, Volume 89, Issue 2, 2023, Pages 309-315, ISSN 0190-9622,

https://doi.org/10.1016/j.jaad.2023.01.043.

Summary By: Christine C. Moon