Why Your Optometrist Should Know That You’re Atopic

Before I continue, I would like stress that nothing you read here should cause you to stop using your medications as prescribed. I am not a medical professional and I am not providing medical advice. These are things you must discuss with your doctor. The only thing that should change is that you should make an effort to get regular ocular screenings (i.e.: See your optometrist!).

It’s not something my dermatologists or immunologists have ever discussed with me. Until I started working in an ophthalmic practice, I had no idea that there was a link between atopy and certain eye conditions. My optometrists certainly never asked if I had eczema. It turns out the two seemingly disparate fields are connected.

People with atopic conditions may be at risk of developing cataracts and glaucoma due to the use of steroids. However, the actual risk is difficult to quantify. The data and evidence isn’t there. According to the University of Maryland Medical Center, the risk of developing cataracts is well-known with oral steroids, but less clear and sometimes contradictory regarding inhaled and nasal-spray corticosteroids.

The American Academy of Allergy, Asthma and Immunology answered this question as recently as March 2012. However, even their response was tempered. The data does not exist to support a clear answer either way. One of the recommendations included in the abstracts contained in the article is that steroid nasal sprays should remain prescription medications to ensure monitoring by a medical professional.1

I recently started using a new nasal spray for my allergic rhinitis. Since, I always read the instructions, I couldn’t help but miss the note about talking to your doctor if you have glaucoma or making sure to have regular eye exams to screen for glaucoma. While this may seem precautionary since there is no clear data, it’s a reasonable precaution. Glaucoma screening is an easy enough thing to have done.

Regarding the risk of topical steroids, once again, the data is not clear. However, the general recommendations seem to be that the use of steroid creams should be limited around the eye in case a link to glaucoma exists.2 Eyelids are made up of a thin layer of skin, allowing the steroid to be more easily transmitted to the eye which is why this area is of more concern than others.

Lastly, according to, for those who have severe eczema around the eyes, complications such as blepharitis and conjunctivitis can occur. These are conditions which can also affect the quality of your vision.

The important thing is to be aware of these conditions and have open discussions with your all of your doctors about ways you can reduce your risks and the potential of developing these eye conditions in order to develop a screening plan. Once again, do not discontinue the use of any of your medications. Risks in medicine are not an absolute and these conditions need many, many years of exposure before potential manifestation. With proper screening and early diagnosis, these conditions can be managed with often excellent results.


1. Bielory L, Blaiss M, Lieberman P, et al. “Concerns about intranasal corticosteroids for over-the-counter use: position statement of the Joint Task Force for the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology.” Ann Allergy Asthma Immunol. 2006 Apr;96(4):514-25. as included in , American Academy of Allergy Asthma & Immunology

2. Garrott HM, Walland MJ. Clin Experiment Ophthalmol. 2004 Apr;32(2):224-6.





(University of Maryland Medical Centre)

(American Academy of Allergy Asthma and Immunology)

(Asthma UK)

(American College of Allergy, Asthma and Immunology)



I developed eczema within a few days after my birth and from the ages of nine to 17, I began to develop other atopic conditions, environmental, animal and food allergies, including eggs, dairy, shellfish and some nuts. Now, in my 30s, I have a good handle on everything, but I’m always trying to see how I can make things better by living a healthier lifestyle. My background includes public relations and healthcare communications. So, I use my skills to share my atopic and allergic experiences on my blog – Atopic Girl’s Guide to Living, with the goal of helping allergic and atopic teens and adults, since growing up and dealing with allergies and atopy is a lesson in itself. I also microblog on Twitter @AtopicGirl It's not just about figuring out what to eat. It's about finding out how to live well!

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