Atopic Dermatitis Severity, Age at Diagnosis May Increase Risk of Ophthalmic Diseases

Moderate-to-severe disease, childhood onset, and systemic treatments were all associated with a greater risk of conjunctivitis in patients with atopic dermatitis, whereas use of soft and hard contact lenses were linked with risk of keratitis.

Incidence of conjunctivitis and other ocular surface diseases (OSDs) may be greater in at-risk patients with atopic dermatitis (AD) who have severe disease and other inflammatory conditions, according to study findings published in Journal of The European Academy of Dermatology and Venereology.

AD, a prevalent inflammatory skin disease that often begins in early childhood, has been associated with an increased risk of OSDs, with factors such as treatment with dupilumab and other interleukin (IL)-13 inhibitors having been associated with an increased occurrence, most commonly conjunctivitis.

“The Hanifin and Rajka criteria for AD include ophthalmological signs as recurrent conjunctivitis, keratoconus, and anterior subcapsular cataract as a part of the minor criteria, indicating that these conditions are a part of the AD syndrome,” researchers explained.

Noting the lack of knowledge regarding incidence, patient characteristics, and risk factors of OSDs in those with AD, they conducted a nationwide cross-sectional questionnaire survey of adult patients with AD from Denmark registered in the National Patient Register between 2000-2019 and 7044 (n = 7044; mean [SD] age, 39.0 [15.5] years; 67.4% female).

Participants were examined for the primary outcomes of OSD prevalence and severity, according to Ocular Surface Disease Index (OSDI). OSDs assessed for included conjunctivitis, blepharitis, keratitis, keratoconus, symblepharon, pterygium, and hordeolum.

“The questionnaire contained branching logic questions about patient characteristics, signs, and symptoms of AD, treatment, OSDs, and atopic comorbidities.” AD treatment was classified according to current or previously self-reported use of topical, systemic, and biologic treatment.

Of the study cohort, Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD) criteria identified mild disease in 49% of patients with AD, moderate disease in 35%, severe disease in 10%, and in 6% AD was inactive. Moreover, 44.3% reported physician-diagnosed asthma bronchiale and 55.8% reported rhinitis.

Lifetime prevalence of OSDs was 66.6% for conjunctivitis, 63.5% for hordeolum, 11.0% for blepharitis, 9.7% for keratitis, 2.0% for pterygium, 1.5% for symblepharon, and 1.1% for keratoconus, and 12.7% reported current conjunctivitis.

Several factors were shown to be associated with lifetime occurrence of conjunctivitis:

  • Mild AD (adjusted odds ratio [aOR], 1.48; 95% CI, 1.02-2.14)
  • Moderate AD (aOR, 1.73; 95% CI, 1.19-2.53)
  • Severe AD (aOR, 2.17; 95% CI, 1.42-3.21)
  • Asthma bronchiale and rhinitis (aOR, 1.76; 95% CI, 1.49-2.07)
  • Childhood-onset of AD (aOR, 1.34; 95% CI, 1.16-1.56)
  • Systemic AD treatment (aOR, 1.27; 95% CI, 1.08-1.50)

Use of soft and hard contact lenses were also shown to be associated with lifetime occurrence of keratitis (soft contact lenses: aOR, 2.15; 95% CI, 1.65-2.80; hard contact lenses: aOR, 3.35; 95% CI, 1.62-6.92). Higher severity of OSDs reported using the OSDI was shown in patients with moderate and severe AD and those with asthma bronchiale and rhinitis.

“Clinicians should be aware of ocular symptoms and signs in patients with AD and treat these when present, and refer when appropriate,” concluded researchers. “Further research is needed to investigate prognostic factors for the development of OSDs in adult AD patients.”


Rønnstad ATM, Hansen PM, Halling AS, et al. Factors associated with ocular surface disease and severity in adults with atopic dermatitis: a nationwide survey. J Eur Acad Dermatol Venereol. Published online November 23, 2021. doi:10.1111/jdv.17832