2013年7月27日土曜日

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.

Sorry, the comment column is not available now. But the author believes readers can find some hints to overcome their own situations by the previous comments.


9 件のコメント:

  1. Very very helpful. Thank you for sharing this to all of us. Keep blogging. My arizona eye care doctor appreciates this so much!

    返信削除
  2. Thank you for this post. I have developed cataract in my left eye due to steroid use of topical, oral and also injections over the past 25 years. I had my eyes examined and found out about a year ago. However the eye doctor told me to wait till I'm older then to do cataract surgery since I'm only 30 years old. After reading your post I'm very worried about retinal detachment. I will have my eyes tested again after I feel better with my TSW/A. I'm only in second month at the moment. It's very hard as I have two young babies to look after and have no time to rest. If I do cataract surgery I'm worried I can't do anything for awhile until my eye is back to normal.

    返信削除
  3. Thanks for taking the time to post such valuable information. Quality content is what always gets the visitors coming.
    prescription glasses online

    返信削除
  4. Thank you for sharing this very important info Dr. Fukuya. We have posted a link to your book and blog in our ITSAN forum as well. I've had eye problems of red, bloodshot, sore, dry, fluid leaking, photo sensitivity and the eye doctor saw an "injury" on my right cornea he was puzzled by. I told him it must be the steroids which he had a hard time believing. I don't! I encourage all members to get their eyes examined and refer them to this page. Thanks again! xx

    返信削除
  5. I read your blog and really like it and getting it very very helpful for me. Thanks for sharing your blog with all of us. Keep blogging....
    okulista wroclaw

    返信削除
  6. Hi Dr Fukuya, my daughter has eczema. She had a very bad eyes allergy back in Sept 2013. Initially, it started with tearing. I used salt and warm water to wash the eyes. That sustained for 1 - 2 months and then it got worst. She had lots of discharged every morning when she woke up. After that, we brought her to see ophthalmologist. He prescribed steroid drops as he said her eyes were badly swollen. After using it for 1 week, her eyes were better. Then her eyes got swollen again. This time, another type of steroid was introduced and she got healed. He told me that she needs to be on anti-histamine drop daily to prevent it. So, I used it for a week and then her eyes got swollen again and this time was pretty bad because it was very painful and she barely can opened her eyes. Then, I brought her to see 2nd ophthalmologist. The 2nd ophthalmologist said my daughter had ulcer at the eye cornea due to excessive of rubbing and blinking. It will impaired her vision. So, she needs to be on 4 hourly drops of steroid and anti inflammation. We did that for 1 week, she got better, however the ulcer was still there (but it was reduced). The dr prescribed another steroid to apply at night for a week to treat it actively, however, I only use it for 3 days but just continue on the 4 hourly steroid drops. And I stop applying for the next 3 days.
    So far she is doing ok, but on and off, she will complain that her eyes are itchy and she will rub. I am hesitant to put her on daily anti histamine drop. I only apply on her eyes if the itchiness is really bad.
    What will be your advice on my daughter's condition. Knowing that long term on anti histamine is not good as the dr said, she will need to use it until she reaches 16 - 18 years old. And this only affect her right eye.

    返信削除
    返信
    1. Anti-histamine doesn’t cause addiction. You can use it under periodically consultation with an ophthalmologist safely. Topical steroid drop neither cause addiction on conjunctiva because it is a mucosal membrane ( not skin). But the skin around the eyes can be addicted. The situation is called as “ocular rosacea”. I recommend you search “ocular rosacea” by search engine.

      削除
    2. does it mean that anti histamine is good to use for the next 12 years? any side effects after using such a pro-long time?
      No more steroid drops on her. That is why I have to choose the lesser of the 2 devils to prevent the bad episode again.
      Thank you and I will do my reading on ocular rosacea.

      削除
  7. Hi
    Nice post. Most of the times i never spend a most of the time on any posts. But i really like you post and i read your post. Thank you for sharing and keep posting a more post on new topics

    返信削除

Comments will appear after approval. Please wait for a while.