BACKGROUND: BACKGROUND: Atopic dermatitis (AD), also called atopic eczema, is a chronic disease of the skin, which affects about 10% of the population. AD manifests as a rash on the face, upper/lower extremities, or the entire body. The cause of AD is unknown. Since the peri-orbital skin and the crystalline lens are derived from the same area of surface ectoderm in the embryo, patients with atopic dermatitis involving the lids often develop cataracts. This has been estimated to be a 10% occurrence rate of rapidly developing, mainly posterior subcapsular, cataracts (PSC).
CASE REPORT: A 46 year old white female presented with long-standing atopic dermatitis, but with recent development of a "butterfly rash" of her lids and periorbital dermal areas. She also complained of significantly reduced vision (20/30 OD, 20/200 OS). Slit lamp exam revealed posterior subcapsular cataracts OS>>OD. She had presented 10 months earlier with the PSCs and subjective vision loss, but with only slightly reduced acuity (20/20 OD, 20/25 OS). In a clinical presentation 16 months earlier her vision was 20/20 in each eye, without any lens changes. Examination also revealed bilateral lattice degeneration with atrophic holes in each eye in both the superior and inferior retinae. She was referred for small incision cataract extraction with foldable IOL implantation. Postoperatively she has 20/20 vision in each eye with no progression of her peripheral retinal disease.
CONCLUSIONS. CONCLUSION: Due to the common embryological origin of the peri-ocular skin and the crystalline lens, there is a higher risk of cataract development in atopy patients with lid involvement. Although the cause of atopic dermatitis is not known, it is logical that there is an underlying inflammatory process involving circulating factors that recognize both of these tissues, simultaneously attacking the lid and lens. Since PSCs are derived from lens epithelial cells that fail to properly differentiate into lens fibers, it is reasonable to expect that, in this case, it is primarily the lens epithelium that is affected by these factors, with the often rapid development of the PSC requiring prompt surgical intervention. There is an additional issue regarding atopy, in that there is an increased risk of retinal detachment in patients with this condition. Thus, surgical intervention to remove cataracts may increase this risk, especially if there is underlying peripheral retinal disease, as was true in this case. The use of minimally invasive small incision extraction techniques along with careful dilated follow-up is, therefore, prudent.