Bidirectional Association between Atopic Dermatitis, Conjunctivitis and other Ocular Surface Diseases:A Systemic Review and Meta-Analysis

BACKGROUND: Conjunctivitis and several other ocular surface diseases (OSDs) have been linked to atopic dermatitis (AD) and its treatment.OBJECTIVES: To examine the association between AD, conjunctivitis and other OSDs.METHODS: A systematic review and meta-analysis was performed. Two authors independently searched EMBASE, PubMed, SCOPUS and Web of Science, performed title/abstract and full-text review and data abstraction. Pooled random-effects prevalence and odds ratios (OR) with 95% confidence intervals (CI) were estimated.RESULTS: The search yielded 5,719 non-duplicate articles, 134 were included in the quantitative analysis. AD was associated with conjunctivitis compared to reference individuals (OR 2.78, 95% CI 2.33-3.32); the prevalence of conjunctivitis in AD patients and reference individuals being 31.7% (95% CI 27.7-35.9) and 13.3% (95% CI 11.0-15.7), respectively. Keratoconus (OR 3.71, 95% CI 1.99-6.94) and ocular herpes simplex (OR 3.65, 95% CI 2.04-6.51) were also associated with AD.LIMITATIONS: Disease definitions differed and often relied on self-reports. Few studies provided data concerning AD phenotype or OSDs other than conjunctivitis.CONCLUSIONS: Conjunctivitis is the most common ocular comorbidity in AD. Signs and symptoms of conjunctivitis and other OSDs in AD may be underreported, making proactive inquiry and examination by physicians treating AD patients important.