Atopic Dermatitis Eye Complications: How to Protect Your Vision

Atopic dermatitis, the most common type of eczema, can develop on your eyelids and around your eyes, leading to itchy skin and red, swollen eyes.

Here’s how to spot signs of eye complications that are associated with atopic dermatitis and prevent lasting damage to your vision.

Atopic dermatitis can cause symptoms around the eye area, and sometimes lead to complications.

“When eczema affects the skin around the eyes, that skin can become irritated and scaly,” says Gerami Seitzman, MD, an ophthalmologist and the medical director of the Francis I. Proctor Foundation for Research in Ophthalmology at UCSF Health in California. “Often the skin itches a lot and can also become irritated and sometimes swollen.”

According to Evan Rieder, MD, a dermatologist in private practice in New York City, signs of eye complications due atopic dermatitis may also include:

• Issues with vision
• Irritation or pain in the eyeball
• Pink or redness in the eye
• Eyelid swelling
• Drainage from the eye

• Keratitis, or Inflammation of the Cornea Atopic dermatitis can lead to irritation and inflammation of the cornea, the dome-shaped clear tissue on the front of the eye, says Shahzad Mian, MD, an ophthalmologist and the chair of ophthalmology and visual sciences at the University of Michigan Medical School in Ann Arbor. This can lead to “pain, light sensitivity, and loss of vision,” Dr. Mian says. See your doctor if you have these or other symptoms of keratitis, such as discomfort in the eye or if your eyes feel gritty or like you have something in them, as the condition can usually be cured if caught early. “In severe cases, vision loss can be permanent,” Mian adds.
• Keratoconus Atopic dermatitis around the eyes can sometimes lead to a condition in which the cornea bulges outward. “Since itchy eyes and discomfort can lead to rubbing of eyes, there is also an association with keratoconus, with irregularities in the shape of the cornea and progressive vision loss,” Mian says. Call your doctor right away if you have any signs of keratoconus, such as nearsightedness; blurry vision; sensitivity to light, especially when driving at night; and constantly changing your prescription for eyeglasses or contacts. Waiting too long to seek treatment can cause vision loss.
• Conjunctivitis People with atopic dermatitis around the eyes are more prone to eye infections, including pink eye, or conjunctivitis, Mian says. This can be associated with redness, tearing, crusting of the eyelids, and itchy eyes, he notes.
• Greater Risk of Cataracts Atopic dermatitis can increase your risk of developing cataracts, or cloudiness that forms in the normally clear lens of the eye. “Atopic cataracts develop in patients with long-standing atopic disease of 10 or more years,” says Tanya Kormeili, MD, a clinical professor in the department of dermatology at the UCLA David Geffen School of Medicine and a dermatologist in private practice in Santa Monica, California. Cataracts can lead to vision problems and can be removed only with surgery.

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• Spontaneous Retinal Detachment Research suggests that this condition, in which the retina becomes separated from its supporting tissue, is more common in patients with atopic dermatitis than in the general population.

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• Scarring Finally, in very rare cases, scarring can occur in various parts of the eye, Mian says.

To prevent vision trouble, see your doctor as soon as you notice any symptoms of atopic dermatitis-related eye complications. Be prepared for the doctor to examine your eyes and ask when the symptoms began and if anything in particular may have caused the flare-up.

The reason that people with atopic dermatitis have an increased risk of vision problems lies in the very nature of this skin condition. “People with eczema often are atopic, meaning they have a tendency to be allergic to many substances,” says Dr. Seitzman. “When the delicate lining on the surface of the eye responds to numerous allergens, the eye itself can become red and inflamed.”

What’s more, patients with atopic dermatitis are more prone to infections in and around the eyes, Seitzman says. “When eyes itch severely, some people rub their eyes repeatedly and aggressively,” she says. “This constant eye rubbing can also cause eye damage.”

There are many creams and ointments for the treatment of atopic dermatitis, ranging from over-the-counter preparations to prescription corticosteroid creams, Seitzman says.

In some cases, your doctor or dermatologist may recommend treatment by an ophthalmologist.

“Any time inflamed eyes and eyelids are associated with decreased vision, an ophthalmologist should be brought in as part of the evaluation team,” Seitzman says. “When steroids are used around and in the eyes, it is very important for an ophthalmologist to follow along so that eye pressure can be monitored. Steroids can affect the eyes in several ways, and monitoring for these side effects requires specialized tools to measure and visualize eye health.”

“Often, but not always, people with eczema have known triggers to their flares,” Seitzman says. “Sometimes the trigger can be certain seasons or sometimes certain chemicals or other irritants. It is good to avoid contact with known triggering agents. Sometimes specialized patch testing can help reveal which triggers to avoid.”

Dr. Rieder also advises keeping your skin clean and moisturized. “Cleanse with hydrating cleansers, and moisturize with hypoallergenic ointments or creams around the eyes regularly,” he says.

To reduce the chance of skin infections and eye problems, it is important to avoid rubbing and scratching the area, Seitzman says. Keep your fingernails short to prevent extra damage if scratching does occur.

“Cool compresses are good tools to minimize the itching sensation,” Seitzman adds. “Antihistamine drops are good to minimize ocular [eye] itching.”

Atopic dermatitis, or eczema, can cause vision problems, swelling, redness, pain, and drainage around the eyes, as well as increasing a person’s risk of vision issues like keratitis, conjunctivitis, cataracts, and retinal detachment. People with eczema may experience allergic reactions that affect the thin tissue of the eye, and rubbing the eye to relieve itching may also cause damage.

A wide variety of over-the-counter ointments and prescription steroid creams are available, but getting advice from a dermatologist or ophthalmologist is vital before using these — the eyes are sensitive, and steroid creams have some links to glaucoma if a person uses them incorrectly. Avoiding known eczema triggers, cleansing and moisturizing the skin, and resisting the urge to rub and scratch the skin may help to reduce the chances of flare-ups and related eye problems.