An 18‐year‐old Male with Severe Bilateral Cataracts and Atopic Dermatitis—A Case Report and Review of the Literature

Abstract

The association of atopic dermatitis (AD) with cataract formation was first reported in 1914 (1). Despite this early recognition, a unifying explanation for cataract progression in patients with AD is lacking. A cataract is an opacity of the lens which can lead to loss of vision. The general classification of cataract includes nuclear, cortical and posterior subcapsular subtypes. The atopic cataract (AC) typically begins as a posterior and ⁄ or anterior subcapsular opacity with eventual development into a fully mature cataract (2,3) (Figs. 1 and 2). They are most often bilateral and are primarily seen in adolescents and young adults. Although cataracts are known to be associated with AD, this seems to be an underappreciated phenomenon. CASE REPORTAn 18-year-old, Filipino American male, was followed for a longstanding history of asthma, allergic rhinitis, food allergy, and AD. His asthma was well controlled with inhaled corticosteroids (ICS). His AD had been present since childhood, and controlled with topical emollients, pimecrolimus 1% cream, and cetirizine. There was no other significant past medical history.At age 15 he described decreasing visual acuity. At this time an optometrist diagnosed him with an early cataract in his left eye. Over the next 12 months, his vision worsened to the extent that it was performance limiting in school and fell outside of the legal driving limits. Two years after his initial unilateral cataract diagnosis; he was diagnosed with visually significant bilateral cataracts. He denied eye pruritis, burning, discharge, redness or eyelid dermatitis. He denied any application of topical steroid medications to the face or around the eyes. He remained on a moderate dose of inhaled corticosteroid for asthma (fluticasone propionate ⁄ salmeterol diskus 250 lg ⁄ 50 lg), and a nasal corticosteroid for allergic rhinitis. Physical exam revealed postinflammatory hyperpigmentation on his face and periorbital region. The patient had diffuse xerosis over his trunk and extremities. He admitted to frequent tapping or rubbing of his face and body because of pruritis.After the development of the second cataract an extensive laboratory workup to rule out a systemic cause of progressive cataracts was unrevealing. Upon presentation to the ophthalmologist, the patient's visual acuity was 20 ⁄ 60 right eye and 20 ⁄ 100 left eye. The anterior ocular exam showed moderate hyperkeratosis of the eyelid skin, healthy bulbar conjunctiva, palpebral conjunctiva with fine papillae and corneal epithelium with only few punctuate epithelial erosions indicating mild ocular surface involvement. The changes in the left lens were denser than the right lens, both including a whitish nuclear sclerosis with posterior and anterior subcapsular changes in a rosette formation as well as wrinkling of the anterior lens capsule (Fig. 3). No lens ⁄ zonule instability

Evaluation of lens clarity in children with atopic dermatitis: A densitometric analysis with Pentacam

“…Cytotoxic anti‐lens epithelium‐derived growth factor is another mediator that increases the defense of the lens against abnormal proteins. Decreased superoxide dismutase activity has also been shown in the development of cataract in AD 8,9 . Cataract is seen in the subcapsular region in AD.…”

Association of Pediatric Atopic Dermatitis and Cataract Development and Surgery

“…7,9,[12][13][14]34 Historically, atopic cataract occurr in about 5% to 38% of patients with AD. [12][13][14] However, most of these studies are hospital-based and conducted within a single hospital, which might be influenced by selection bias. 6,[12][13][14] The present study estimated the incidence probabilities of cataract and cataract surgery by the use of a na- tionwide, population-based, incident AD cohort in a longitudinal manner.…”

“…[12][13][14] However, most of these studies are hospital-based and conducted within a single hospital, which might be influenced by selection bias. 6,[12][13][14] The present study estimated the incidence probabilities of cataract and cataract surgery by the use of a na- tionwide, population-based, incident AD cohort in a longitudinal manner. In our results, the incidence probability of cataract was 0.216% in patients with AD and 0.520% in patients with severe AD at 10-year follow-up, which were lower than those reported in previous studies.…”

Family-based whole exome sequencing of atopic dermatitis complicated with cataracts

“…From 1940 to 1953, an ophthalmological check in 1,158 AD patients showed typical atopic cataract in 136 patients (11.7%) including 79 cases of visual disturbance [ 6 ]. To date, literatures describing cataracts in AD are mainly from Asian populations, including the Japanese population reporting the incidence of atopic cataracts around 10-15% [ 7 ], Filipino population [ 8 ] and Singapore population without Chinese population. Based on this, it seems that a greater interest may exist in Asians, or the prevalence and significance of this disease is greater in these populations.…”