Ophthalmological complications

“You don’t need to visit any dermatologist including me, but you should visit an ophthalmologist periodically.” That was my habitual saying to patients with atopic dermatitis.

 There are several ophthalmological complications in atopic dermatitis. Well, I will make a question about it.

 You should clear the exam before treating your atopic dermatitis by yourself. Never feel easy about ophthalmological complications only because you are seeing some dermatologist. They see only your skin and never see your eyes.

 Which is the ophthalmological complication in atopic dermatitis?

a.cataract  b.retinal detachment  c.conjunctivitis d.keratoconus e.glaucoma

1.a  2.a,b  3.a,b,c,d  4.all 5.none

  Atopic cataract occurs suddenly. Though steroids can induce cataract, atopic cataract occurs regardless of steroid therapy. There were patients with atopic cataract several decades ago when steroids were not yet invented.

 Cataract has a tendency to develop a while after severe dermatitis has subsided. Some dermatologists criticize TSW insisting that TSW is the cause of cataract. But it is a ridiculous theory because the cause of TSW (A) is topical steroids. Bad dermatologists neglect their duty to give information about ophthalmological complication before the patients develop cataract and blame their TSW after the development of cataract. 

 When cataract is developed, the patient’s pupil becomes cloudy. It occurs one day and progresses in a few days. It is just like you have a drip of milk in your eye. Fortunately, cataract can be treated by operation. You can recover eyesight. Ophthalmologists might use eye drops of topical steroids for the purpose of conditioning the situations around the operation. You should not be so nervous but you can request of the ophthalmologist to refrain from using it if you never like to use it. Usually ophthalmologists are not so stubborn about topical steroids and accept your request.

 Anyway, your cataract should be operated not only because you could recover eyesight but also because it will help an early identification of retinal detachment.

 Retinal detachment in atopic dermatitis starts in the peripheral parts of the retina. It is the part of difficulty in examination. If there were untreated cataract, ophthalmologists couldn’t check the part.

 If the retinal detachment is identified early when it is small, laser therapy can stop the progression. So it is very important to find out as early as possible.

 Retinal detachment is considered to be caused by the repeated or frequent banging to the skin around the eyes. Mechanical vibration is an inducement. So we dermatologists often warn patients not to bang around the eyes but the stress of the patients become increased by the warning itself and they bang or spank more and more. Nobody seems to be able to stop it. So I recommend patients to visit an ophthalmologist at least. The damage would become the least by examining the retina periodically.

 Conjunctivitis is a symptom of allergy. Sometimes the cornea is also damaged mechanically because of the mucosal roughness of the eyelid side of the conjunctiva. Keratoconus is completely a complication of atopic dermatitis itself. The eyesight of the patient with keratoconus can be corrected by the contact lens.

 Glaucoma is the side effect of steroids or antihistamines if the ocular tension decreases by stopping those drugs. Glaucoma is never a complication of atopic dermatitis. So the answer of the above question is 3.

 I used to introduce all patients with atopic dermatitis to the ophthalmological department first of all before I myself see the patients. I am now retired but if I had continued to see TSA/W patients after resigning the national hospital, I would have studied ophthalmology and equipped with the instruments of funduscopy and slit lamps in my clinic. It is so important a problem.

 If the patient is an infant or a child, you need not become so nervous. But even a child also can develop cataract if the dermatitis is severe. Keep being careful.

 Now I will refrain my usual almost habitual saying again. You, patients with atopic dermatitis don’t need to come to dermatologists including me but you should visit to an ophthalmologist periodically. They will not prescribe any medicine but examine your eyes. It is very important.
 

PS:　In Japan, patients can see an ophthalmologist (eye doctor) for the purpose of only examinations under the public health insurance at the cost of about 30 USD. Patients usually don’t need to make any reservation or appointment. I don’t know how much it costs or how hard it is to make a reservation overseas. If you have any experience of seeing an ophthalmologist, please leave a comment for the exchange of information.

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