Skip to main content
SpringerLink
Log in

Augenbeteiligung bei atopischer Dermatitis

Klinik und Therapie

Ocular involvement in atopic dermatitis

Clinical aspects and therapy

  • Leitthema
  • Published:
Der Ophthalmologe Aims and scope Submit manuscript

Zusammenfassung

Patienten mit einer atopischer Dermatitis klagen häufig im Krankheitsverlauf über Beschwerden mit den Augen. Dabei ist zum einen die periokuläre Haut direkt an der Dermatitis beteiligt, und zum anderen kommt es häufig zu einer chronisch verlaufenden Blepharokeratokonjunktivitis. Die frühzeitige Diagnosestellung der charakteristischen ophthalmologischen Veränderungen (wie Blepharitis, allergische Konjunktivitis, Conjunctivitis sicca, Bindehautvernarbungen mit Symblepharonbildung und Lidfehlstellung, filiforme Keratitis, Bildung kornealer Plaques, [persistierende] Erosio, Hornhautulzera, Keratokonus etc.) und die entsprechende stadiengerechte Therapie (von der Lidrandpflege mit konservierungsmittelfreier Benetzung über eine topische und ggf. systemische antiinflammatorische Therapie bis zu chirurgischen Maßnahmen etc.) sind für die Betroffenen von großer Bedeutung, um langfristige Schäden an den Augen und eine damit einhergehende Sehbehinderung zu verhindern.

Abstract

Patients with atopic dermatitis frequently complain of ocular symptoms. The general dermatitis can directly affect the periocular skin and patients often present with chronic atopic blepharokeratoconjunctivitis. Early diagnosis of the characteristic ophthalmological alterations, such as blepharitis, allergic conjunctivitis, keratoconjunctivitis sicca, conjunctival scarring with formation of symblepharon and lid malpositioning, filiform keratitis, corneal plaques, (persistent) epithelial defects, corneal ulcers and keratoconus as well as appropriate stage-adapted treatment, including lid hygiene with preservative-free lubricants, topical and sometimes systemic anti-inflammatory therapy and surgical treatment are important for patients to prevent long-term damage of the ocular surface leading to severe visual impairment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7

Literatur

  1. Akpek EK, Dart JK, Watson S et al (2004) A randomized trial of topical cyclosporin 0.05 % in topical steroid-resistant atopic keratoconjunctivitis. Ophthalmology 111:476–482. doi:10.1016/j.ophtha.2003.05.035

    Article  PubMed  Google Scholar 

  2. Akyol-Salman I, Azizi S, Mumcu U, Baykal O (2010) Efficacy of topical N‑acetylcysteine in the treatment of meibomian gland dysfunction. J Ocul Pharmacol Ther 26:329–333. doi:10.1089/jop.2010.0001

    Article  CAS  PubMed  Google Scholar 

  3. Amemiya T, Matsuda H, Uehara M (1980) Ocular findings in atopic dermatitis with special reference to the clinical features of atopic cataract. Ophthalmologica 180:129–132

    Article  CAS  PubMed  Google Scholar 

  4. Auw-Hädrich C, Reinhard T (2009) Treatment of chronic blepharokeratoconjunctivitis with local calcineurin inhibitors. Ophthalmologe 106:635–638. doi:10.1007/s00347-009-1954-9

    Article  PubMed  Google Scholar 

  5. Bawazeer AM, Hodge WG, Lorimer B (2000) Atopy and keratoconus: a multivariate analysis. Br J Ophthalmol 84:834–836

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Beetham WP (1940) Atopic cataracts. Arch Ophthalmol 24:21–37

    Article  Google Scholar 

  7. BenEzra D, Pe’er J, Brodsky M, Cohen E (1986) Cyclosporine eyedrops for the treatment of severe vernal keratoconjunctivitis. Am J Ophthalmol 101:278–282

    Article  CAS  PubMed  Google Scholar 

  8. Bielory B, Bielory L (2010) Atopic dermatitis and keratoconjunctivitis. Immunol Allergy Clin North Am 30:323–336. doi:10.1016/j.iac.2010.06.004

    Article  PubMed  Google Scholar 

  9. Bielory L (2000) Allergic and immunologic disorders of the eye. Part II: ocular allergy. J Allergy Clin Immunol 106:1019–1032. doi:10.1067/mai.2000.111238

    Article  CAS  PubMed  Google Scholar 

  10. Bleik JH, Tabbara KF (1991) Topical cyclosporine in vernal keratoconjunctivitis. Ophthalmology 98:1679–1684

    Article  CAS  PubMed  Google Scholar 

  11. Calonge M, Herreras JM (2007) Clinical grading of atopic keratoconjunctivitis. Curr Opin Allergy Clin Immunol 7:442–445. doi:10.1097/ACI.0b013e3282efd0bf

    Article  PubMed  Google Scholar 

  12. Coca AF, Cooke RA (1923) On classification of the phenomena of hypersensitiveness. J Immunol 8(3):163–182

    CAS  Google Scholar 

  13. Coles RS, Laval J (1952) Retinal detachments occurring in cataract associated with neurodermatitis. AMA Arch Ophthalmol 48:30–39

    Article  CAS  PubMed  Google Scholar 

  14. Cordes FC, Cordero-Moreno R (1946) Atopic cataracts; report of four cases. Am J Ophthalmol 29:402–407

    Article  CAS  PubMed  Google Scholar 

  15. Coster DJ (1997) Superficial keratopathy. In: Tasman W, Jaeger EA (Hrsg) Duane’s clinical opthalmology, Bd. 4. Lippincott-Raven, Philadelphia, S 1–13

    Google Scholar 

  16. Cursiefen C, Schaub F, Bachmann B (2016) Update: Deep anterior lamellar keratoplasty (DALK) for keratoconus. When, how and why. Ophthalmologe 113:204–212. doi:10.1007/s00347-015-0204-6

    Article  CAS  PubMed  Google Scholar 

  17. Darsow U, Wollenberg A, Simon D et al (2010) ETFAD/EADV eczema task force 2009 position paper on diagnosis and treatment of atopic dermatitis. J Eur Acad Dermatol Venereol 24:317–328. doi:10.1111/j.1468-3083.2009.03415.x

    Article  CAS  PubMed  Google Scholar 

  18. Dogru M, Katakami C, Nakagawa N et al (1998) Impression cytology in atopic dermatitis. Ophthalmology 105:1478–1484. doi:10.1016/S0161-6420(98)98032-0

    Article  CAS  PubMed  Google Scholar 

  19. Dogru M, Nakagawa N, Tetsumoto K et al (1999) Ocular surface disease in atopic dermatitis. Jpn J Ophthalmol 43:53–57

    Article  CAS  PubMed  Google Scholar 

  20. Easty D, Entwistle C, Funk A, Witcher J (1975) Herpes simplex keratitis and keratoconus in the atopic patient. A clinical and immunological study. Trans Ophthalmol Soc U K 95:267–276

    CAS  PubMed  Google Scholar 

  21. Eberwein P, Auw-Hadrich C, Birnbaum F et al (2008) Corneal melting after cross-linking and deep lamellar keratoplasty in a keratoconus patient. Klin Monbl Augenheilkd 225:96–98. doi:10.1055/s-2008-1027128

    Article  CAS  PubMed  Google Scholar 

  22. Foster CS, Calonge M (1990) Atopic keratoconjunctivitis. Ophthalmology 97:992–1000

    Article  CAS  PubMed  Google Scholar 

  23. Foster CS (1997) The eye in skin and mucous membrane disorders. In: Duane’s clinical opthalmology. Lippincott-Raven, Philadelphia, S 1–41

    Google Scholar 

  24. Fukushima A, Ohashi Y, Ebihara N et al (2014) Therapeutic effects of 0.1 % tacrolimus eye drops for refractory allergic ocular diseases with proliferative lesion or corneal involvement. Br J Ophthalmol 98:1023–1027. doi:10.1136/bjophthalmol-2013-304453

    Article  PubMed  PubMed Central  Google Scholar 

  25. Garrity JA, Liesegang TJ (1984) Ocular complications of atopic dermatitis. Can J Ophthalmol 19:21–24

    CAS  PubMed  Google Scholar 

  26. Geggel HS (1994) Successful penetrating keratoplasty in a patient with severe atopic keratoconjunctivitis and elevated serum IgE level treated with long-term topical cyclosporin A. Cornea 13:543–545

    Article  CAS  PubMed  Google Scholar 

  27. Ghoraishi M, Akova YA, Tugal-Tutkun I, Foster CS (1995) Penetrating keratoplasty in atopic keratoconjunctivitis. Cornea 14:610–613

    Article  CAS  PubMed  Google Scholar 

  28. Gold MH, Picascia DD, Roenigk HHJ (1989) Treatment-resistant atopic dermatitis controlled with cyclosporin A. Int J Dermatol 28:481–482

    Article  CAS  PubMed  Google Scholar 

  29. Guglielmetti S, Dart JK, Calder V (2010) Atopic keratoconjunctivitis and atopic dermatitis. Curr Opin Allergy Clin Immunol 10:478–485. doi:10.1097/ACI.0b013e32833e16e4

    Article  CAS  PubMed  Google Scholar 

  30. Herbort CP, Zografos L, Zwingli M, Schoeneich M (1988) Topical retinoic acid in dysplastic and metaplastic keratinization of corneoconjunctival epithelium. Graefes Arch Clin Exp Ophthalmol 226:22–26

    Article  CAS  PubMed  Google Scholar 

  31. Hoang-Xuan T, Prisant O, Hannouche D, Robin H (1997) Systemic cyclosporine A in severe atopic keratoconjunctivitis. Ophthalmology 104:1300–1305

    Article  CAS  PubMed  Google Scholar 

  32. Hogan MJ (1952) Atopic keratoconjunctivitis. Trans Am Ophthalmol Soc 50:265–281

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Hu Y, Matsumoto Y, Dogru M et al (2007) The differences of tear function and ocular surface findings in patients with atopic keratoconjunctivitis and vernal keratoconjunctivitis. Allergy 62:917–925. doi:10.1111/j.1398-9995.2007.01414.x

    Article  CAS  PubMed  Google Scholar 

  34. Hurlbut WB, Domonkos AN (1954) Cataract and retinal detachment associated with atopic dermatitis. AMA Arch Ophthalmol 52:852–857

    Article  CAS  PubMed  Google Scholar 

  35. Johansson SGO, Bieber T, Dahl R et al (2004) Revised nomenclature for allergy for global use: report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol 113:832–836. doi:10.1016/j.jaci.2003.12.591

    Article  CAS  PubMed  Google Scholar 

  36. Kallen C, Reinhard T, Schilgen G et al (2003) Atopic keratoconjunctivitis: probably a risk factor for the development of conjuntival carcinoma. Ophthalmologe 100:808–814. doi:10.1007/s00347-003-0809-z

    Article  CAS  PubMed  Google Scholar 

  37. Kerr N, Stern GA (1992) Bacterial keratitis associated with vernal keratoconjunctivitis. Cornea 11:355–359

    Article  CAS  PubMed  Google Scholar 

  38. Klemens F (1962) Dermatosis, cataract and retinal detachment. Klin Monbl Augenheilkd Augenarztl Fortbild 140:657–663

    CAS  PubMed  Google Scholar 

  39. Lang SJ, Böhringer D, Geerling G, Reinhard T (2016) Long-term results of allogenic penetrating limbo-keratoplasty: 20 years of experience. Eye (Lond). doi:10.1038/eye.2016.217

    PubMed Central  Google Scholar 

  40. Lang SJ, Messmer EM, Geerling G et al (2015) Prospective, randomized, double-blind trial to investigate the efficacy and safety of corneal cross-linking to halt the progression of keratoconus. BMC Ophthalmol 15:78. doi:10.1186/s12886-015-0070-7

    Article  PubMed  PubMed Central  Google Scholar 

  41. Leonardi A, De Dominicis C, Motterle L (2007) Immunopathogenesis of ocular allergy: a schematic approach to different clinical entities. Curr Opin Allergy Clin Immunol 7:429–435. doi:10.1097/ACI.0b013e3282ef8674

    Article  CAS  PubMed  Google Scholar 

  42. Lyons CJ, Dart JK, Aclimandos WA et al (1990) Sclerokeratitis after keratoplasty in atopy. Ophthalmology 97:729–733

    Article  CAS  PubMed  Google Scholar 

  43. Mayer K, Reinhard T, Reis A et al (2001) FK 506 ointment 0.1 % – A new therapeutic option for atopic blepharitis. Clinical trial with 14 patients. Klin Monbl Augenheilkd 218:733–736. doi:10.1055/s-2001-18665

    Article  CAS  PubMed  Google Scholar 

  44. Messner K, Leibowitz HM (1971) Acetylcysteine treatment of keratitis sicca. Arch Ophthalmol 86:357–359

    Article  CAS  PubMed  Google Scholar 

  45. Nanji AA, Sayyad FE, Karp CL (2013) Topical chemotherapy for ocular surface squamous neoplasia. Curr Opin Ophthalmol 24:336–342. doi:10.1097/ICU.0b013e3283622a13

    Article  PubMed  Google Scholar 

  46. Nelson MN (1988) Topical retinoic acid treatment for conjunctival squamous metaplasia. Arch Ophthalmol 106:1723

    Article  CAS  PubMed  Google Scholar 

  47. Nivenius E, van der Ploeg I, Jung K et al (2007) Tacrolimus ointment vs steroid ointment for eyelid dermatitis in patients with atopic keratoconjunctivitis. Eye (Lond) 21:968–975. doi:10.1038/sj.eye.6702367

    Article  CAS  Google Scholar 

  48. Ohashi Y, Ebihara N, Fujishima H et al (2010) A randomized, placebo-controlled clinical trial of tacrolimus ophthalmic suspension 0.1 % in severe allergic conjunctivitis. J Ocul Pharmacol Ther 26:165–174. doi:10.1089/jop.2009.0087

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Power WJ, Tugal-Tutkun I, Foster CS (1998) Long-term follow-up of patients with atopic keratoconjunctivitis. Ophthalmology 105:637–642. doi:10.1016/S0161-6420(98)94017-9

    Article  CAS  PubMed  Google Scholar 

  50. Rahi A, Davies P, Ruben M et al (1977) Keratoconus and coexisting atopic disease. Br J Ophthalmol 61:761–764

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Raizman MB, Rothman JS, Maroun F, Rand WM (2000) Effect of eye rubbing on signs and symptoms of allergic conjunctivitis in cat-sensitive individuals. Ophthalmology 107:2158–2161

    Article  CAS  PubMed  Google Scholar 

  52. Reinhard T, Reis A, Mayweg S et al (2002) Topical Fk506 in inflammatory corneal and conjunctival diseases. A pilot study. Klin Monbl Augenheilkd 219:125–131. doi:10.1055/s-2002-26727

    Article  PubMed  Google Scholar 

  53. Reinhard T, Ruzicka T, Sundmacher R (1999) Pathogenesis, clinical aspects and therapy of eye involvement in allergy. Ophthalmologe 96:473–488

    Article  CAS  PubMed  Google Scholar 

  54. Reinhard T, Sundmacher R (1992) Perforating keratoplasty in endogenous eczema. An indication for systemic cyclosporin A – a retrospective study of 18 patients. Klin Monbl Augenheilkd 201:159–163. doi:10.1055/s-2008-1045885

    Article  CAS  PubMed  Google Scholar 

  55. Remitz A, Reitamo S (2009) Long-term safety of tacrolimus ointment in atopic dermatitis. Expert Opin Drug Saf 8:501–506. doi:10.1517/14740330902969441

    Article  CAS  PubMed  Google Scholar 

  56. Remitz A, Virtanen HM, Reitamo S, Kari O (2011) Tacrolimus ointment in atopic blepharoconjunctivitis does not seem to elevate intraocular pressure. Acta Ophthalmol 89:e295–e296. doi:10.1111/j.1755-3768.2009.01834.x

    Article  PubMed  Google Scholar 

  57. Rich LF, Hanifin JM (1985) Ocular complications of atopic dermatitis and other eczemas. Int Ophthalmol Clin 25:61–76

    Article  CAS  PubMed  Google Scholar 

  58. Rikkers SM, Holland GN, Drayton GE et al (2003) Topical tacrolimus treatment of atopic eyelid disease. Am J Ophthalmol 135:297–302

    Article  CAS  PubMed  Google Scholar 

  59. Roat MI, Ohji M, Hunt LE, Thoft RA (1993) Conjunctival epithelial cell hypermitosis and goblet cell hyperplasia in atopic keratoconjunctivitis. Am J Ophthalmol 116:456–463

    Article  CAS  PubMed  Google Scholar 

  60. Ruzicka T (1997) Atopie und atopisches Ekzem. In: Dermatologie und Venerologie, 4. Aufl. Springer, Berlin, S 445–460

    Google Scholar 

  61. Ruzicka T, Wüthrich B (1997) Das integrierte Therapiekonzept des atopischen Ekzems. Implementierung ganzheitlicher und naturheilkundlicher Prinzipien in der universitären Medizin. Dtsch Arztebl 94:A1874–A1880

    Google Scholar 

  62. Secchi AG, Tognon MS, Leonardi A (1990) Topical use of cyclosporine in the treatment of vernal keratoconjunctivitis. Am J Ophthalmol 110:641–645

    Article  CAS  PubMed  Google Scholar 

  63. Shields CL, Kaliki S, Kim HJ et al (2013) Interferon for ocular surface squamous neoplasia in 81 cases: outcomes based on the American Joint Committee on Cancer Classification. Cornea 32:248–256. doi:10.1097/ICO.0b013e3182523f61

    Article  PubMed  Google Scholar 

  64. Sowden JM, Berth-Jones J, Ross JS et al (1991) Double-blind, controlled, crossover study of cyclosporin in adults with severe refractory atopic dermatitis. Lancet 338:137–140

    Article  CAS  PubMed  Google Scholar 

  65. Tuft SJ, Kemeny DM, Dart JK, Buckley RJ (1991) Clinical features of atopic keratoconjunctivitis. Ophthalmology 98:150–158

    Article  CAS  PubMed  Google Scholar 

  66. Williams DL (1997) A comparative approach to topical cyclosporine therapy. Eye (Lond) 11(Pt 4):453–464. doi:10.1038/eye.1997.126

    Article  Google Scholar 

  67. Zug KA, Palay DA, Rock B (1996) Dermatologic diagnosis and treatment of itchy red eyelids. Surv Ophthalmol 40:293–306

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Augenheilkunde, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland

    P. Maier, T. Lapp & T. Reinhard

Authors
  1. P. Maier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Lapp
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Reinhard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Maier.

Ethics declarations

Interessenkonflikt

P. Maier, T. Lapp und T. Reinhard geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maier, P., Lapp, T. & Reinhard, T. Augenbeteiligung bei atopischer Dermatitis. Ophthalmologe 114, 514–524 (2017). https://doi.org/10.1007/s00347-017-0473-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00347-017-0473-3

Schlüsselwörter

Keywords

Search

Navigation