Title : Ocular changes in patients with atopic dermatitis and long-term steroid usage.
Abstract:
Atopic dermatitis (AD) is a chronic inflammatory skin condition that can present with ocular comorbidities. Ocular complications are more prevalent in individuals with AD compared to the general population and can cause notable ocular morbidity. A general understanding of the diagnosis and treatment of atopic eye disease may assist dermatologists to proactively inquire about the symptoms and timely referral to ophthalmologists thereby preventing irreversible vision loss. [1] Also, AD itself and long term steroids (>1month) [2] use have many side effects from blepharitis to ocular hypertension.
The objective of the study was to correlate the common ocular complications associated with AD and long term steroid use.This was a prospective, randomized, open label study of 64 subjects. Also, the ocular findings were compared with 120 control of the same age group. After taking written informed consent from the parents, all children of AD >5years of age , control subjects and those with long term steroid usage were examined for ocular changes. Out of them, we found the highest association with keratoconjunctivitis (OR, 7; 95% CI, 3.19-15.31), blepharitis (OR 4.21; 95% CI, 3.21-12.02) and dry eye (OR, 6.24; 95% CI, 2.62-11.10;). Also, there was association seen with severe ocular disorders like glaucomatous optic neuropathy (OR, 0.16; 95% CI, 0.07-0.34;) and cataracts (OR, 0.21; 95% CI, 0.10-0.42). Amongst children with long term steroid usage, strong association was seen with ocular hypertension (OR 5.02, 95% CI, 2.14-11.32) and cataracts (OR 6.2, 95%CI, 3.24-10.02). P value <0.001 in all cases was significant.
Our findings concluded that the risk of ocular complications is higher amongst AD subjects and more in the group who have been using long term steroid for AD management. Timely intervention can be done if the findings are diagnosed early in the disease process to prevent vision loss and associated comorbidities.
Audience Take Away Notes:
- The study will assist dermatologists in early prevention of ocular comorbidities in AD subjects.
- As practicing dermatologists, all of us are aware about the recurring nature of AD and the need of long tern steroid usage in the management. The disease itself and the use of steroid is associated with many ocular complications which are not diagnosed on time. The study will aid in the timely recognition of these disorders.
- The study will also help ophthalmologists to intervene the ocular disease process as soon as the diagnosis is made.
- The study will help prevent disease burden of AD and the related ocular complications in the society.
- The economical burden to the patients will be less if the diagnosis is made earlier in the disease course.
- The diagnostic and management approach can also be taught to the medical residents in dermatology and the training ophthalmologists.
