Skin disorders encompass a broad spectrum of conditions that affect the integumentary system, the largest organ in the human body [1]. These conditions range from inflammatory diseases such as psoriasis and atopic dermatitis to autoimmune disorders like systemic lupus erythematosus and infectious conditions including herpes zoster [2]. While the primary clinical manifestations of these disorders are dermatological, they can frequently extend beyond the skin to involve other organs, notably the eyes [3]. Several dermatological diseases commonly exhibit ocular involvement. For instance, herpes zoster ophthalmicus (HZO), caused by the reactivation of the varicella-zoster virus, presents with vesicular eruptions along the ophthalmic division of the trigeminal nerve. In its mild form, HZO may cause conjunctivitis and superficial keratitis, while severe cases can lead to neurotrophic keratopathy and sclerokeratitis [4]. Another one is atopic dermatitis (AD), affecting 15–20% of individuals in industrialized nations, commonly includes ophthalmic complications like keratoconjunctivitis, cataracts, and glaucoma. These conditions are often multifactorial, influenced by immune dysregulation and medication side effects [5]. Similarly, psoriasis is known to present with ocular manifestations in approximately 10% of patients. The ocular symptoms associated with this chronic inflammatory condition are diverse and can significantly impact a patient's quality of life. Common ocular complications include conjunctivitis, characterized by inflammation of the conjunctiva, blepharitis, which involves inflammation of the eyelids and their margins, and keratitis, an inflammation of the cornea that can potentially affect vision if left untreated [6,7]. Although rare, Stevens-Johnson syndrome (SJS) is a severe and potentially life-threatening mucocutaneous reaction characterized by extensive epidermal necrosis and detachment. This condition often results in significant ocular complications, which can be both acute and chronic in nature. Among the most serious ocular outcomes are symblepharon, an adhesion between the conjunctiva of the eyelid and the eyeball, corneal ulceration that can cause severe pain and visual impairment, and in the most extreme cases, progressive damage that may lead to permanent blindness if not adequately managed [8]. In autoimmune conditions like pemphigus, autoantibodies targeting skin structures can also affect ocular tissues, leading to a range of manifestations from dry eye to severe uveitis [9]. Neurofibromatosis (NF), a genetic disorder affecting neural tissue growth, is classified into NF1 and NF2. Ocular complications such as eyelid neurofibromas often appear early in life and can obstruct the visual axis, causing mechanical ptosis [10]. Despite the well-established connection between skin disorders and ocular manifestations, the recognition of these associations in clinical practice remains a challenge. Dermatologists and ophthalmologists often work in silos, leading to missed opportunities for early diagnosis and intervention. This is particularly concerning in resource-limited settings where access to specialized care is limited [11]. There is a need for greater awareness and collaboration between dermatology and ophthalmology to ensure comprehensive care for patients with skin disorders [12]. Understanding the underlying mechanisms is essential for developing targeted therapies that address both dermatological and ocular symptoms. This study aims to investigate the ocular manifestations associated with various dermatological conditions. It seeks to understand the prevalence, patterns, and clinical implications of eye involvement in patients with skin disorders, emphasizing the importance of multidisciplinary care for early diagnosis, effective management, and prevention of vision-threatening complications.

This observational prospective study was conducted at World Medical College, Jhajjar, with approval from the Institutional Review Board. Written informed consent was obtained from all participants. The study included outpatients and inpatients from the Departments of Ophthalmology and Dermatology over a period of two years, from [start date] to [end date]. A total of 120 patients with dermatological diseases presenting ocular manifestations were included in the study.

Inclusion Criteria

Patients of any age and gender presenting with dermatological diseases with concurrent ocular findings.

Exclusion Criteria

Patients who were unwilling to participate in the study, as well as those suffering from mental, neurological, or debilitating illnesses that hindered proper

Ocular Investigations

Best-corrected visual acuity was measured using a Snellen chart for each patient. Intraocular pressure was measured in all indicated cases. If corneal epithelial defects or erosions were observed, corneal staining was conducted using 2% fluorescein strips. Schirmer’s test was performed for five minutes using Whatman® number 41 filter paper to diagnose dry eye disease. Patients suspected of having glaucoma were referred for further investigations, such as perimetry and optical coherence tomography (OCT). In cases where orbital involvement was suspected, radiological investigations including X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans were conducted as necessary.

Data Collection and Examination

A comprehensive ophthalmic evaluation was conducted for all enrolled patients. The preliminary ophthalmic examination was performed using oblique illumination and a slit lamp to assess the ocular involvement, noting external deformities and adnexal involvement. Extraocular movements were assessed in all patients, followed by a detailed slit lamp examination. The anterior segment, vitreous body, and posterior segment were evaluated. Indirect ophthalmoscopy and biomicroscopy were performed to assess retinal involvement, and intraocular pressure (IOP) was measured using the Goldmann applanation tonometer.

Additional investigations such as corneal staining and gonioscopy were performed based on clinical indications. Fundus photography was taken in cases of retinal involvement. Patients with ocular involvement were advised conservative medical management, which included topical cycloplegics, steroids, antibiotics, artificial tears, and lid taping, as deemed appropriate by the ophthalmologist.

Statistical Analysis

Data were analyzed using SPSS (version 26.0). Continuous variables were expressed as mean ± standard deviation, and categorical variables were expressed as frequencies and percentages.

The mean age of the study population was 49.54±6.88 years. The majority of the participants were male (65.83%) (Table 1). Eyelid and conjunctival findings shows that Blepharitis was most common in acne (4.17%) and herpes zoster ophthalmic (HZO) (1.67%). Ectropion was exclusively observed in ichthyosis (6.67%), while plexiform neurofibromas were specific to neurofibromatosis (4.17%). Scarring and vesicles were primarily associated with HZO (5.0% and 18.33%, respectively). Stye was noted in acne (1.67%), pemphigoid (2.5%), and HZO (1.67%). Conjunctivitis was prevalent in HZO (6.67%), psoriasis (5.83%), and ichthyosis (4.17%), while papillary conjunctivitis was noted in atopic dermatitis (0.83%). Pseudomembrane formation occurred in Steven Johnson's syndrome (1.67%) (Table 2). According to corneal and uveal findings, Corneal endotheliitis was identified in cases of pemphigoid (0.83%), herpes zoster ophthalmic (HZO) (3.33%), and neurofibromatosis (NF) (0.83%). Epithelial keratitis was predominantly seen in HZO (9.17%), with Hutchison's sign appearing in 3.33% of these cases. Keratic precipitates were observed in HZO (4.17%) and psoriasis (0.83%), while corneal opacification was noted in acne (0.83%) and Steven Johnson's syndrome (SJS) (0.83%). Anterior uveitis was most frequently linked to HZO (2.50%) and psoriasis (4.17%). Iris pearls were associated with atopic dermatitis (1.67%) and SJS (0.83%), whereas Lisch nodules were infrequent, occurring in ichthyosis (0.83%) and psoriasis (0.83%) (Table 3). Table 4 exhibits that Atopic dermatitis (0.83%), Steven Johnson's disease (1.67%), and neurofibromatosis (NF) all showed anterior subcapsular cataracts. Nuclear cataracts were seen in ichthyosis (1.67%) and herpes zoster ophthalmic (HZO) (10%), whereas cortical cataracts were most common in psoriasis (0.83%) and HZO (7.5%). NF (0.83%), HZO (5.83%), and acne (0.83%) all had pseudopseudophakia. Changes in the glaucomatous optic nerve head were found in psoriasis (0.83%), pemphigoid (1.67%), and atopic dermatitis (0.83%) (Table 4).

Table 1: Demographic characteristics of the study population (N=120)

Table 2: Eyelid and conjunctival findings in skin diseases (N=120)

Steven Johnson's syndrome (SJS), Herpes zoster ophthalmic (HZO), Neurofibromatosis (NF).

Table 3: Cornea and uvea findings in dermatology diseases (N=120)

Table 4: Lens and optic nerve head findings in skin diseases (N=120)

This observational study analyzed 120 patients with dermatological diseases, emphasizing the intricate interplay between dermatological diseases and ocular health. It reveals that 65.83% were males and 34.17% were females. The age range of the patients was diverse, with a mean age of 49.54 years. Similar findings were reported by Damor et al. (2022), who noted a male predominance, especially in the 21–30-year age group, in their study of dermatological conditions [13]. Several skin conditions in the study demonstrated significant ocular complications. In cases of ichthyosis, particularly its severe forms such as lamellar ichthyosis, eyelid abnormalities were frequently observed. One notable condition, ectropion, where the eyelids turn outward, was prevalent. This abnormality prevents proper eyelid closure, exposing the cornea to environmental insults and increasing the risk of exposure keratopathy. The study revealed that up to 50% of patients with severe ichthyosis developed ectropion, emphasizing the need for consistent ophthalmologic assessments for these patients [14]. Psoriasis, another skin condition studied, showed ocular involvement in 10–20% of cases. Symptoms ranged from conjunctival injection to significant dry eye complaints. The presence of blepharitis and other eyelid-related disorders added to the ocular challenges faced by psoriasis patients. These findings stress the importance of close collaboration between dermatologists and ophthalmologists to address these multifaceted issues effectively [15]. Herpes Zoster Ophthalmicus (HZO) was associated with significant corneal complications. Epithelial keratitis, observed in 9.17% of patients with HZO, was a common finding. If left untreated, this condition could lead to severe corneal damage, underscoring the importance of prompt intervention [16]. Moreover, anterior uveitis was documented in patients with HZO and neurofibromatosis, suggesting that systemic inflammation linked to these skin diseases can extend to the eyes, resulting in potentially serious consequences. These findings highlight the necessity of comprehensive eye evaluations in patients with systemic or dermatological diseases to mitigate the risk of ocular complications [15]. Additional findings included keratic precipitates and corneal opacification in patients with various dermatological conditions, further underlining the importance of routine eye examinations. Lens-related issues, such as nuclear cataracts, were predominantly observed in HZO patients, with an incidence of 10%. This association suggests that prolonged inflammation or systemic disease processes related to skin conditions may contribute to the development of cataracts over time [15,16]. Glaucomatous changes were noted in patients with pemphigoid and psoriasis. These findings suggest a possible link between these skin conditions and increased intraocular pressure or optic nerve damage, necessitating regular monitoring for glaucoma [15]. The findings underscore the need for a multidisciplinary approach, combining dermatologic and ophthalmologic expertise, to ensure timely diagnosis and management of ocular complications in patients with skin disorders.

Limitations of the study: This study has certain limitations. The observational nature of the study does not allow for the establishment of causal relationships between dermatological conditions and their ocular complications. The exclusion of patients with mental, neurological, or debilitating illnesses, as well as those unwilling to participate, may introduce selection bias. The lack of long-term follow-up precludes assessment of the progression of ocular manifestations or the effectiveness of therapeutic interventions over time.a

This study highlights the significant association between dermatological diseases and ocular manifestations, emphasizing the diverse spectrum of ocular complications in conditions like herpes zoster ophthalmicus, psoriasis, atopic dermatitis, ichthyosis, and neurofibromatosis. Key findings include the prevalence of eyelid abnormalities, conjunctivitis, anterior uveitis, and cataracts among patients, underscoring the intricate interplay between systemic and ocular health. The results emphasize the need for integrated dermatological and ophthalmological care to ensure early diagnosis, targeted management, and prevention of vision-threatening complications in patients with skin disorders.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee.

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