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Abstract ID: 24-106
Consequences of eyelid dermatitis: a case of ocular surface disease, recurrent graft rejections, and advanced glaucoma
Ehi Inegbedion
Purpose
Atopic dermatitis, impacting 20% of children and 3% of adults globally, presents risks to ocular health, causing complications like blepharitis and keratoconus. Complex pathophysiology involves inflammation, immune dysregulation, compromised skin barriers, bacterial colonization, and viral susceptibility. Timely recognition and management are vital to prevent devastating ocular complications and improve quality of life. In this case, we present a detailed clinical narrative of a patient with a history of atopic dermatitis with significant eyelid involvement, offering insights into the spectrum of ocular complications that may ensue when this condition is not adequately addressed.
Methods
A 54-year-old woman with atopic eczema since early childhood presented with persistent periocular eczema, initially managed with topical steroids. Despite improvement, progressing keratoconus caused visual decline. Seven years later, following multiple missed appointments, she presented with corneal hydrops and bilateral corneal scars due to recurrent microbial keratitis.
Results
After the acute infections had settled, the patient underwent bilateral penetrating keratoplasties. Despite an uncomplicated surgery and frequent topical steroid drops, low grade ocular surface inflammation persisted due to severe atopic dermatitis, so the patient was started on systemic immunosuppression, oral mycophenolate, and tacrolimus, to reduce the risk of wound dehiscence. However, during the follow-up at two months, there was clinical evidence of ongoing lid margin disease and subsequent left corneal graft rejection.
Conclusion
Our case illustrates severe ocular complications from eyelid dermatitis, leading to endophthalmitis. Emphasizing collaborative care between ophthalmologists and dermatologists is crucial. Increasing awareness of ophthalmic complications, encouraging early symptom inquiries, and adopting a joint approach for high-risk patients can enhance coordination between specialties and improve overall patient outcomes, preventing vision loss.
Additional Authors
Yu Jeat Chong – Sandwell and West Birmingham Hospitals NHS Trust