Published On: Feb 25, 2021
Last Updated On: Aug 28, 2024
The itching and inflammation of eczema can be aggravating at the best of times. When it affects the eyelids, it can be especially tough to deal with. Since eyelid skin is thin, sensitive and close to the eyes, symptoms may not only be magnified, but also more challenging to treat. The good news is that with a diagnosis and appropriate care, eyelid eczema can be controlled.
Three types of eczema may occur on the eyelids: contact dermatitis, atopic dermatitis and seborrheic dermatitis.1-3 Research shows that contact dermatitis is most prevalent, followed by atopic and seborrheic dermatitis.1-4
Contact dermatitis occurs when the skin reacts to allergens or irritants in the environment. These can include airborne substances like animal dander,2 personal care products such as cosmetics,2-4 metals2 or even topical medications.2,4 Pinpointing the allergen or irritant causing your skin to react is the key to treating this condition.
Research shows allergic contact dermatitis is more common than irritant contact dermatitis on the eyelids.1-3
The best way to diagnose contact dermatitis is to see an allergist or dermatologist. This can also help you identify the irritant or allergen at the root of the problem. Once you know which substances are causing a reaction, you can take steps to minimize or avoid contact with them. If your contact dermatitis is caused by personal care products, stop using them or choose hypoallergenic versions.
Airborne allergens can be more difficult to avoid. Morgan Maier, a dermatology physician assistant at Seattle Children’s Hospital in Washington, recommends washing your face or showering at the end of the day to minimize exposure to them.
“If it’s a pollen allergy, I recommend trying to keep the allergen out of your house,” said Maier. She advises patients with dust mite allergies to use mattress and pillow protectors.
Doctors may also recommend medication to control contact dermatitis, especially if the root cause has yet to be identified.
Atopic dermatitis is thought to be caused by a combination of genetic and environmental factors. Some common triggers are dry skin, irritants (e.g., laundry detergents or personal care products) and stress.
To treat atopic dermatitis on the eyelids, doctors may prescribe a medication. Keeping the skin moisturized and managing stress may also help prevent flares.
Seborrheic dermatitis can appear on the face, head, upper chest and back where there are oil-producing glands.
Like atopic dermatitis, seborrheic dermatitis is thought to be caused by genetic and environmental conditions. In some cases, it may be associated with an inflammatory reaction to a type of yeast (Malassezia) that grows naturally on the skin. Symptoms can be triggered by stress,5 cleaning agents, hormonal changes, cold weather, specific medicines and other conditions.
“As of now, we don’t have specific treatments for seborrheic dermatitis of the eyelids, and this can often present a challenge,” said Dr. Zelma Chiesa Fuxench, a dermatologist at the Hospital of the University of Pennsylvania and assistant professor of dermatology at the University of Pennsylvania.
She also explained that seborrheic dermatitis can look similar to atopic dermatitis on the eyelids, making diagnosis difficult.
In terms of treatment, Dr. Chiesa Fuxench said medications are frequently prescribed off-label for seborrheic dermatitis. This means they have been approved for a different condition.
Due to the sensitivity and fragility of the eyelids, doctors must use extra caution when prescribing medications for eyelid eczema. The skin by your eyes is very thin. You also don’t want to get medication in your eyes or cause damage to your eyes.
Dr. Chiesa Fuxench explained that prolonged use of mid- to high-potency topical steroids on the eyelids is associated with atrophying skin and developing cataracts or glaucoma. “It is preferable to avoid the use of topical steroids in this area,” she said.
Luckily there are other options. Dr. Chiesa Fuxench suggests topical calcineurin, PDE4 and JAK inhibitors as alternatives to steroid treatments. She cautioned that some calcineurin and PDE4 inhibitors can sting when applied to flaring skin. She explained that ruxolitinib cream has “less risk of a burning or stinging sensation.”
Medicines should be applied with care to prevent them from irritating the eyes. Maier said to use a thin coat of ointment — a pea-sized amount or less. “If there’s so much that it’s goopy or there’s a layer that you could remove with your finger, you’re putting on too much,” she said.
Maier tells patients to stop applying medical ointment one or two millimeters (the width of a cotton swab stick) from the lash line to ensure it doesn’t get too close to the eyes. She also counsels them to avoid the area close to the tear ducts.
Maier recommends dabbing the medicine instead of rubbing it in, especially for parents applying it for their children. “Dabbing is more gentle for the eye,” she said.
In addition to your doctor’s recommendations, there are other things you can do to manage itch and pain from an eyelid flare at home.
Maier recommends putting moisturizer in the fridge to cool and then dabbing it on the affected area. She also suggests laying a cold cloth compress filled with rice on the eyelids. Another option is to use a sock stuffed with rice and tied with a knot.
Moisturizing can be a good way to prevent flares, but it’s important to take special care when choosing and applying ointments or lotions to the eyelid area. Choosing products free of triggering ingredients is essential.
“I ask patients to look for keywords in the labeling or package that say ‘fragrance and dye free’ and ‘dermatologist or ophthalmologist tested,’” said Dr. Chiesa Fuxench. “I also recommend patients look for the National Eczema Association’s Seal of Acceptance™ as these products have been developed or intended primarily for use in people with sensitive skin, such as patients with eczema.”
Maier recommends using an ointment, lotion or hypoallergenic eye cream twice daily.
Above all, make sure you have a good healthcare provider in your corner. If you don’t have a doctor who deals specifically with eczema, it’s worth finding one in your area. And don’t wait too long before seeking advice.
“I recommend that patients reach out to me as quickly as possible if they experience a flare or are not experiencing results with their currently prescribed topical medications,” said Dr. Chiesa Fuxench. “This gives us an opportunity to act early on and quickly.”
Morgan Maier is a dermatology physician assistant at Seattle Children’s Hospital in Washington.
Dr. Zelma Chiesa Fuxench is a dermatologist at the Hospital of the University of Pennsylvania and assistant professor of dermatology at the University of Pennsylvania.
In this video, Dr. Peter Lio, a dermatologist and clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine, and co-founder and co-director of the Chicago Integrative Eczema Center, discusses eyelid eczema and treatment options.
References:
1. Ayala F, Fabbrocini G, Bacchilega R, et al. Eyelid dermatitis: an evaluation of 447 patients. Am J Contact Dermat. 2003;14(2):69-74.
2. Guin JD. Eyelid dermatitis: experience in 203 cases. J Am Acad Dermatol. 2002;47(5):755-765. doi:10.1067/mjd.2002.122736
3. Luz Fonacier, Mark Boguniewicz. Chapter 53: Contact Dermatitis. In: Leung DYM, Szefler SJ, Bonilla FA, Akdis CA, Sampson HA, eds. Pediatric Allergy: Principles and Practice. 3rd ed. Elsevier; 2016:467-481. https://www.sciencedirect.com/topics/immunology-and-microbiology/eyelid-dermatitis
4. Landeck L, John SM, Geier J. Periorbital dermatitis in 4779 patients - patch test results during a 10-year period. Contact Dermatitis. 2014;70(4):205-212. doi:10.1111/cod.12157
5. Misery L, Touboul S, Vinçot C, et al. Stress et dermatite séborrhéique [Stress and seborrheic dermatitis]. Ann Dermatol Venereol. 2007;134(11):833-837. doi:10.1016/s0151-9638(07)92826-4
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