Adults with atopic dermatitis may face more than the familiar skin and ocular surface problems associated with the condition. New research links atopic dermatitis with a substantially higher risk of retinal detachment, along with more complicated outcomes after retinal repair.
That connection matters because atopic dermatitis is common and often managed primarily as a dermatologic condition, while retinal detachment is a time-sensitive eye emergency that can threaten vision. The findings suggest that a history of atopic dermatitis may deserve more attention when patients report new visual symptoms or require follow-up after retinal surgery.
The association does not mean retinal detachment is inevitable in people with atopic dermatitis, and the available data cannot prove that the condition directly causes retinal disease. Even so, the size of the U.S. cohort and the consistency of the risk signal make the connection clinically relevant.
Atopic Dermatitis Has Ocular Effects Beyond the Skin
Atopic dermatitis, commonly called eczema, is a chronic inflammatory condition associated with immune dysregulation and recurring skin inflammation. It affects millions of adults and has increasingly been recognized as a condition with effects that can extend beyond the skin.
Ocular complications have been documented in people with atopic dermatitis for years. Irritation around the eyes, chronic inflammation, and repeated eye rubbing have all raised concern about how the condition may affect ocular health over time.
Eye rubbing has received particular attention because periocular itching can lead to frequent or forceful rubbing. Repeated mechanical stress has been discussed as a possible contributor to retinal problems in this population, especially in earlier reports of retinal detachment associated with atopic dermatitis.
What has been less clear is how much retinal detachment risk differs across a large population of adults with and without atopic dermatitis, and whether that risk extends beyond the first retinal event into the postoperative period.
A Large U.S. Cohort Showed a Clear Difference in Risk
Researchers at the Keck School of Medicine of the University of Southern California examined de-identified electronic health record data from the TriNetX U.S. Collaborative Network. The database included information from dozens of healthcare organizations across the United States and allowed researchers to compare retinal outcomes in adults with and without a history of atopic dermatitis.
Adults aged 18 years and older were identified using diagnostic codes from March 2006 through March 2026. The initial analysis included 285,408 patients with atopic dermatitis and more than 2.8 million without the condition.
After propensity score matching, 274,547 patients remained in each group. Matching was used to balance characteristics that could influence retinal risk, including demographics, ocular comorbidities, tobacco use, and systemic corticosteroid exposure.
That last factor was particularly important because systemic corticosteroid use was much more common among patients with atopic dermatitis before matching. Balancing those differences helped reduce some of the obvious sources of bias, although no retrospective analysis can account for every possible influence.
Retinal Detachment Was More Common With Atopic Dermatitis
At five years, retinal detachment had been diagnosed in 0.7% of patients with atopic dermatitis compared with 0.2% of matched controls. The hazard ratio was 2.74, showing that retinal detachment occurred at a substantially higher rate in the atopic dermatitis group during the follow-up period.
Retinal detachment repair showed an even larger difference. About 0.2% of patients with atopic dermatitis underwent repair compared with 0.04% of controls, with a hazard ratio of 4.56.
The absolute percentages remain small, which is important when putting the findings into perspective. Most patients with atopic dermatitis did not develop retinal detachment during the period studied.
The difference between the matched groups is still meaningful. It suggests that atopic dermatitis may be an underrecognized factor in retinal risk, particularly when considered alongside other clinical signs, symptoms, and known risk factors.
For eye care professionals, that added context may be most useful when a patient with atopic dermatitis develops sudden flashes, new floaters, a curtain or shadow in the visual field, or an abrupt change in vision. Those symptoms already require prompt evaluation, and a history of atopic dermatitis may strengthen the reason to take retinal concerns seriously.
The Concern Continued After Retinal Repair
The increased risk did not end with the initial detachment. Researchers also examined outcomes among patients who underwent retinal detachment repair, comparing 1,689 patients with atopic dermatitis with the same number of matched controls.
Within six months of the initial repair, proliferative vitreoretinopathy, or PVR, was diagnosed in 5.9% of patients with atopic dermatitis compared with 4.0% of controls. The hazard ratio was 1.45.
PVR is an important complication of retinal detachment because scar-like tissue can form on or beneath the retina, creating traction that may contribute to recurrent detachment and more complex surgical management.
Complex retinal detachment repair was also more common in the atopic dermatitis group. It occurred in 8.9% of patients with atopic dermatitis compared with 6.6% of matched controls, with a hazard ratio of 1.36.
Those differences extend the concern beyond whether a detachment occurs in the first place. Atopic dermatitis may also be relevant during recovery and follow-up, particularly when clinicians are watching for signs of PVR, recurrent detachment, or the need for more involved surgical intervention.
The postoperative findings are not large enough to suggest that every patient with atopic dermatitis will have a difficult recovery. They do, however, support greater awareness when these patients are already under retinal care.
Chronic Inflammation and Eye Rubbing May Both Be Involved
The mechanism behind the association remains uncertain, and there may not be a single explanation.
Chronic inflammation is one possibility. Atopic dermatitis involves persistent immune dysregulation, and systemic inflammatory activity could potentially influence retinal tissue or postoperative healing. That possibility is biologically plausible, but it has not been proven as the cause of the higher retinal risk seen in this population.
Eye rubbing is another plausible contributor. Patients with itchy periocular skin may rub their eyes frequently or forcefully, creating repeated mechanical stress. Earlier clinical reports involving atopic dermatitis and retinal detachment have also pointed to this behavior as a possible factor.
The electronic health record data could not capture how often patients rubbed their eyes, how forcefully they did so, or whether that behavior changed over time. That leaves an important part of the picture unresolved.
The higher retinal risk may reflect inflammation, eye rubbing, other unmeasured factors, or a combination of several influences. Future prospective work will be needed to sort out how much each factor contributes.
The Association Still Needs Careful Interpretation
The scale of the database is a strength, but the retrospective design brings important limitations.
Diagnoses and procedures were identified through electronic health record coding, which creates the possibility of incomplete documentation, coding error, and misclassification. Propensity score matching can reduce measured differences between groups, but it cannot account for every variable that might affect retinal detachment risk.
Residual confounding remains possible, especially from behaviors such as eye rubbing that were not available in the database. Other unmeasured differences between patients with and without atopic dermatitis could also have influenced the results.
The postoperative analysis has another specific limitation. Although the records could identify a later diagnosis of PVR, they could not confirm whether that complication occurred in the same eye that underwent the original retinal detachment repair.
That matters because it limits how confidently the postoperative complication can be linked to the operated eye. The association is still noteworthy, but it needs to be interpreted with that uncertainty in mind.
These limitations do not erase the difference seen between the groups. They do reinforce the importance of treating the findings as an association rather than proof that atopic dermatitis directly causes retinal detachment or postoperative complications.
Greater Awareness May Be the Most Immediate Clinical Takeaway
For clinicians, the most useful implication may be greater awareness rather than a change in routine screening policy.
A history of atopic dermatitis may provide meaningful context when patients report symptoms that could indicate retinal detachment. That does not change the urgency of classic retinal warning signs, but it may influence how quickly clinicians consider retinal pathology in the differential.
Postoperative care may deserve similar attention. The higher rates of PVR and complex repair in patients with atopic dermatitis suggest that closer awareness after retinal detachment surgery may be reasonable, especially when other risk factors or concerning findings are already present.
Routine retinal screening for every asymptomatic person with atopic dermatitis is a different question. The available evidence does not show whether expanded screening, earlier referral, or enhanced surveillance would improve outcomes.
Prospective research will be needed to determine whether retinal risk varies with the severity or duration of atopic dermatitis, the extent of periocular involvement, treatment history, frequency of eye rubbing, or other clinical characteristics. It will also be important to determine whether any change in surveillance or referral practice actually improves visual outcomes.
For now, the connection broadens the way atopic dermatitis should be considered in eye care. A condition usually managed through a dermatologic lens may also carry meaningful retinal implications, particularly when new symptoms appear or when a patient is recovering from retinal detachment repair.
That makes communication among patients, dermatology professionals, primary care clinicians, and eye care providers increasingly relevant when retinal symptoms or complications enter the picture.
Sources
Hong AT and colleagues. Association of Atopic Dermatitis with Retinal Detachment and Postoperative Proliferative Vitreoretinopathy Risk. Ophthalmology Retina. 2026.
https://doi.org/10.1016/j.oret.2026.05.006
BMC Ophthalmology. Characteristics of retinal detachment associated with atopic dermatitis.
https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-021-02135-7
TriNetX
https://trinetx.com/
