Oct 10, 2019
Atopic dermatitis (AD) is associated with various
ocular comorbidities that can result in permanent vision loss
if left untreated. Dr. Soo Jung Kim talks with Dr. Vincent DeLeo
about the incidence of keratoconjunctivitis, keratoconus, glaucoma,
retinal detachment, and other ocular conditions associated with AD.
Dr. Kim offers tips on spotting these complications and managing
them but also indicates when referral to an ophthalmologist is
We also bring you the latest in dermatology news and
1. Nivolumab-ipilimumab nets long-term survival in advanced
An update of CheckMate 067 finds that with combination nivolumab
and ipilimumab therapy, 52% of patients were alive at 5 years.
2. Lifetime indoor tanning raises risk of cutaneous
squamous cell carcinoma
Researchers found a dose-response association between number of
indoor tanning sessions and SCC risk in Norwegian women.
3. FDA approves afamelanotide for treatment of rare
condition with light-induced pain
This is the first treatment approved to help patients with
erythropoietic protoporphyria increase their exposure to light.
* * *
Things you will learn in this episode:
- Patients with AD may develop blepharitis, presenting with
itching and irritation of the eyelids, as well as tearing, foreign
body sensations, and even photophobia. The mainstay treatment of
blepharitis is good eyelid hygiene with the use of warm compresses
and gentle scrubbing of the lid margins.
- About 25%-52% of patients with AD have atopic
keratoconjunctivitis. Clinicians should look out for red
conjunctivae, hyperemia, and papillary hypertrophy of the
conjunctivae. “Ultimately, if this is not treated in a timely
manner, patients could have visual impairment,” explains Dr.
- Keratoconus is the progressive thinning and bulging of the
cornea that can affect the cornea’s topography. “Patients
experience imaging blurring as well as imaging distortions,” Dr.
Kim describes. “We’re not exactly sure why atopic dermatitis
patients develop more keratoconus, but it’s been believed that
chronic, habitual eye rubbing is most likely to be the cause due to
the periocular itching.”
- “Glaucoma is not necessarily a complication of atopic
dermatitis; it’s more a complication of the steroid use,” explains
Dr. Kim. Glaucoma in AD may be asymptomatic until advanced stages;
therefore, clinicians should regularly screen patients who have a
prolonged history of topical steroid application around the eye
area, a family history of glaucoma, or a history of other ocular
- Cataracts occur in 8%-25% of patients with AD, usually younger
adults. Interior or posterior subcapsular cataracts are more common
in these patients compared to nuclear and cortical cataracts, which
are more common in the general population.
- Routine periodic screening by an ophthalmologist is required
when patients have onset of periorbital atopic dermatitis,
prolonged use of topical or systemic steroids, or a family history
- The incidence of retinal detachment is 4%-8% in patients with
AD. “This is a lot higher than the general population, which is
around 0.005%,” Dr. Kim says. “This retinal detachment occurs
usually more bilaterally at a younger age, compared to cases
without atopic dermatitis.” These patients should be quickly
referred to an ophthalmologist for surgical repair.
- Patients with AD are at greater risk for herpetic ocular
disease, and active ocular herpetic infections require urgent
referral to an ophthalmologist.
- Dupilumab has been associated with ocular complications in
patients with AD.
Soo Jung Kim, MD, PhD (Baylor College of Medicine, Houston,
Show notes by: Jason Orszt, Melissa Sears,
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