Atopic Dermatitis Eye Complications- How to Protect Your Vision?

Are you experiencing itchy, red, and swollen eyelids? Do you find yourself rubbing your eyes frequently? If yes, then there's a high chance that you are suffering from atopic dermatitis. This condition not only affects the skin but can also lead to complications in your vision over time, making it essential for you to take preventative measures. In this blog post, we'll discuss everything that you need to know about atopic dermatitis eye complications and how you can protect your vision from their effects. So read on to learn more!

Atopic Dermatitis or Eczema is a chronic inflammatory disease. It impacts 15-20% of children and 1-3% of adults worldwide. Suprisingly, it has far-reaching consequences on their day-to-day activities, sleep cycles and overall quality of life. The disease starts with dry, itchy skin on the arms and knees before spreading to other parts of the scalp, face and lips.

Atopic dermatitis on the eyes usually starts around the eyes and before affecting the lids, lashes and corneal-conjunctival surface, giving rise to vision disturbances and symptomatic effects. Eventually, the problem spreads to the lens and retina regions and manifests as irreversible visual impairment.

Atopic Dermatitis eye complications

What causes atopic dermatitis eye complications

Sensitive skin is among the chief causes of atopic dermatitis that, in the course of affecting the face, starts around the thin ocular margins and lid surface before breaking the weak skin barrier and impacting the outer and inner layers of the eye. Genetics, a weak immune system, and diet are essential in initiating the changes. Pregnancy conditions, asthma tendencies and climatic changes trigger dryness and subsequent ocular damage.

Some of these ocular complications present with acute symptoms caused by physical trauma when constantly rubbing the eye. Other symptoms present as a chronic, long-standing deficiency, chiefly driven by cellular immune deficiency and elevated Immunoglobulin E levels.

Some of the chief symptoms of atopic dermatitis-induced ey complications are

Sign and Symptoms

• Thickening of the eyelid skin

• Severe itching

• Crusty eyelid margins

• Skin inflammation or edematous reactions

The chief eye complications as a result of atopic dermatitis are

Types of Eye Complications

Blepharitis

Blepharitis is an inflammatory eyelid condition that occurs in approximately 1% of the general population and 6% of atopic dermatitis patients globally. The barrier in the skin surface causes it because of dryness and ceramide ( constituting 30% of corneum stratum ) abnormalities. Itching, burning, swelling, and a stinging sensation are some of the main symptoms of the condition, which presents as flakes and crust around the lashes with the inability to open the eyes in the morning. Blepharitis can be

Anterior blepharitis outside the eye in the lid-lash margin because of Staphylococcal disease

Posterior blepharitis inside the eye in the lid wedge touching the eyes because of structural changes and obstruction to the meibomian orifice.

Treatment for atopic blepharitis usually uses topical Ceramide gel application that nourishes the skin and increases its water content. Topical Antibiotics like Erythromycin and other tetracycline derivatives are advised in anterior blepharitis.

Keratoconjunctivitis

Atopic Keratoconjunctivitis is a chronic ocular eczema manifestation that occurs in people between the ages of 15-55 because of type I (IgE mediated) and type IV (delayed) hypersensitivity reactions.

The condition is characterised by intense bilateral itching of the lids, conjunctiva and periorbital margin, followed by copious mucoid discharge from the eyes. Atopic conjunctivitis in severe infections can lead to cataracts, keratoconus and infectious keratitis.

Treatment of Keratoconjunctivitis is usually through cool compresses, antihistamines and mast cell stabilisers to provide the patient with symptomatic relief.

Keratoconus

Excessive rubbing of the eyes is one of the chief conditions behind atopic dermatitis-induced keratoconus, which has a higher incidence in patients with atopic keratoconjunctivitis. Keratoconus is a non-inflammatory, progressive cornea thinning that gives rise to problems of distorted vision, halo formation and moderate-severe astigmatism.

The treatment form of keratoconus is usually wearing contact lenses that improve vision and relieve the discomfort caused by corneal thinning. Tear-lubrication drops and wearing sun- protective eyewear helps significantly combat dryness and photophobia.

Cataracts

While the exact mechanism behind cataract or cloudy lens formation in atopic dermatitis is unclear, it has been hypothesised that it occurs because of secondary trauma caused by frequent and vigorous rubbing of the eyes. In addition, using steroids indiscriminately to reduce inflammation can lead to secondary cataracts as a side effect.

Cataracts are present as shield-shaped or posterior lenticular abnormalities. They can hamper day-to-day activities and impact sensory development in children on occurring because of atopic dermatitis. Surgically removing cataracts and using alternative treatments instead of steroids are the primary treatment options for decreasing inflammation and improving visual clarity.

Glaucoma and Retina Detachment

Studies have shown allergic conditions to trigger glaucomatous reactions and hamper vision quality. In addition, open-angle glaucoma can result from steroid-induced complications in chronic states of atopic dermatitis.

Retina detachment occurs from tractional breaks to the retina in the vitreoretinal border because of constantly rubbing the eye.

In such conditions, surgical interventions and anti-glaucoma medications help control the damage and protect the residual vision.

How to protect your vision from atopic dermatitis eye complications?

Some of the preventive methods to protect the vision in atopic dermatitis conditions

Practice ocular Hygiene

Cleaning the lids and lashes regularly and using medicated shampoos have been observed to reduce blepharitis and itching conditions to a significant extent. In addition to preventing further flare-ups, a clean ocular surface helps absorb topical treatment options better and quickens the recovery.

Avoid rubbing of eyes

Rubbing of the eyes has been observed to be the chief trigger behind exacerbating the itching and increasing the complications of the cornea, lens and retina margin. Use cold compress or antihistamines to soothe the eyes instead of touching or rubbing them frequently.

Avoid dermal triggers that can exacerbate atopic dermatitis.

External triggers like cosmetics, a dry environment, fur of animals and sometimes allergens in the air can act as dermal triggers and start a case of active ocular inflammation. Identifying the triggers through patch tests and avoiding them can work as a preventative measure.

Use protective eyewear

Protective eyewear includes sunshades to prevent skin inflammation from harmful UV radiation and anti-reflective eyewear to protect your eyes during prolonged screen time and while driving at night.

Avoid indiscriminate use of Steroids.

Steroids are one of the chief reasons behind chronic ocular complications caused by atopic dermatitis-like glaucoma, lens changes, uveitis and retinopathy/ retinal detachment. Instead, use non-steroidal antiinflammatory medications to provide therapeutic relief without damaging the eye.

Conclusion

Atopic dermatitis can lead to long-term eye damage and irreversible vision loss because of its impact on the internal ocular parts and the quality of your life. Timely treatment and preventative measures are vital in ensuring relief from severe itching and preventing loss of vision. At the same time, yearly ocular checkups are equally important to rule out the possibility of retinal, lens or glaucoma changes because of the problem and ensure that your visual acuity is within normal limits.