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Excerpt
AD is associated with a number of ocular complications. Atopic keratoconjunctivitis is one of the most common sequelae, and diffuse edema and papillary reaction of the upper and lower palpebral conjunctivae are observed in patients complaining of typical symptoms of itching and tearing. In severe cases, shield ulcer and epithelial plaque will occur as corneal complications, resulting in corneal scarring with permanent visual impairment.
Atopic cataracts are also a well-known complication of AD, usually involving the anterior subcapsular area. Hence, patients complain of photophobia and visual disturbance, especially in the daytime. Surgical treatment is necessary in some advanced cases.
Keratoconus has a higher incidence in persons with atopic disease. A defect in collagen synthesis may be important in the development of keratoconus, but eye rubbing in persons with atopy may also contribute to this condition. The relationship of eye rubbing to cataract has also been debated.
Rhegmatogenous retinal detachment is one of the most severe complications of AD. Characteristically, retinal breaks around the ora serrata are the cause of retinal detachment, and surgical intervention is mandatory.
Aside from these well-known complications, AD is closely related to the influence of microorganisms. The representative microorganisms are Staphylococcus aureus and herpes simplex virus (HSV). The microorganisms cause various ocular complications and require ophthalmologists to manage and treat AD patients on the basis of a knowledge of these relations. For instance, surgical therapy for cataract or retinal detachment in atopic patients must be carefully undertaken, given the higher risk of ocular infections.
In this chapter, the relation between AD and representative microorganisms, the characteristics of ocular infections in atopic patients, and the management and treatment of these complications are reviewed.
