October 2009




The impact of atopic dermattis

by Matt Young EyeWorld Contributing Editor

Swollen eczematous lids in atopic keratoconjunctivitis Source: Greg Berdy, M.D.

Although atopic dermatitis (AD) predisposes patients to ocular complications, questions about which eye problems surface—and how severe they are—have remained unanswered, especially in the developing world. A new study performed in India, however, is the first of its kind to document just what kind of association between AD in children and ocular manifestations exists. It has yielded insights into the likely nature of AD patients with ocular involvement—this occurs more commonly in males, for instance, contrary to previous reports. The study was published in the March/April 2009 issue of the Indian Journal of Dermatology, Venereology and Leprology.

Potential ocular complications of atopic dermatitis include dermatitis of the eyelids, blepharitis, keratoconjunctivitis, keratoconus, uveitis, cataract, retinal detachment, and ocular herpes simplex, according to study co-author Sanjeev Handa, M.D., Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. This study also provides additional insights into the frequency and significance of ocular manifestations of AD in children.

Ocular factors

Dr. Handa and colleagues analyzed 100 patients with AD between 1 and 14 years old. The mean age was 5.4 years. Severity and extent of AD was assessed using a SCORAD index. Mild disease was characterized as a SCORAD of less than 20, moderate disease included SCORAD scores between 20.1 and 40, and severe disease indicated a SCORAD of greater than 40. Other examinations were also performed. “Of the 100 AD patients, only 43 (43%) had eye involvement,” Dr. Handa reported. “We found ocular involvement to be more common in males, unlike in other studies. Eye findings were limited to only the lid and conjunctiva and no other structure of the eye was affected in any of the patients.”

In fact, the mean SCORAD index was no worse for AD patients with ocular complications than those without them. In the 43 patients who had ocular symptoms, the mean SCORAD index was 13.39, while it was 14.94 in AD patients without ocular complications. This was a statistically insignificant difference. However, ocular manifestations may not have surfaced considerably due to the fact that these AD patients overall had a low SCORAD index. “Serious ocular changes were probably not seen in our patients because the majority had a low SCORAD index,” Dr. Handa reported. “The mean duration of the disease in our patients with ocular changes was 3.6 years and 1.9 years in those without ocular changes.

When arbitrarily classifying the disease duration as less than or more than 1 year, ocular changes were significantly more in AD patients with disease duration of more than 1 year.”

Other important results include the following facts: • Of the AD patients with ocular problems, 18 (41.9%) showed only lid involvement.

• Sixteen of these patients (37.2%) showed only conjunctival problems. • Conjunctival and lid changes were witnessed in nine (20.9%) patients. There was no significant link between facial involvement and ocular changes, although importantly, rubbing of the face to relieve itching was minimal in these AD patients.

Family history may help determine which patients with AD tend to present with ocular complications. “Family history of atopy may be an important predictor for the development of eye changes because a positive family history of atopy was obtained in 19 (44%) of the 43 patients with ocular abnormalities and only 14 (25%) of the 57 patients without ocular abnormalities,” Dr. Handa noted. “Keratoconus in AD patients has been observed in 0.5–9.0%,” Dr. Handa reported. However, no patients in this group had it—perhaps due to their young age, given that the condition reportedly rarely presents in children. To improve the treatment of atopic dermatitis patients with ocular involvement, Quresh B. Maskati, M.S., Maskati Eye Clinic, Mumbai, India, suggested that treating medical specialists need to be aware of related medical problems that surface outside of their sphere of practice. “We often see patients with asthma, atopic dermatitis, and allergic eye disease,” Dr. Maskati said. “Many times these coexist. No one correlates the three, so a child goes to three different doctors for three different therapies.”

Being aware of other medical history and treatment can greatly impact these patients, he said. For instance, if a child on dermatitis medications suddenly stops systemic treatment, a jump in ocular allergy could occur. Wrongly, however, this is often attributed to a seasonal variation in allergies, Dr. Maskati said. Instead, the systemic steroid likely was suppressing the child’s ocular symptoms as well. The bottom line is, if patients come in for ocular allergy treatment, Dr. Maskati said you should be asking if they are being treated for atopic dermatitis or asthma as well. “If the parents say the child is already on 5 mg of steroids orally for asthma, I know the child’s eye symptoms could be much worse—the steroid could just be keeping them down,” Dr. Maskati said. Dr. Maskati said it is therefore important to prescribe ocular medications based on systemic medications.

Editors’ note: Dr. Handa has no financial interests related to this study. Dr. Maskati has no financial interests related to his comments.

Contact information

Handa: handa_sanjeev@yahoo.com
Maskati: qureshmaskati@gmail.com

The impact of atopic dermattis The impact of atopic dermattis
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