Eyelid Dermatitis | Eczema on Eyelids

It is common for people to suffer from eye irritation and problems at least once in their life. This irritation can be due to something bothering the sensitive nerve endings of their eye.

However, there are times when it is not the eyeball causing all the problems, instead it is the skin of the eye causing discomfort. This condition is usually called ‘Eyelid dermatitis.’

Our eyelids form the protective skin barrier, that stops any harmful particles from entering the inside of the eyes. Inflammation of eyelids can happen due to a number of reasons and can result in a condition that causes constant pain and itching.

Types of dermatitis on eyelids

Eyelid dermatitis can involve the lids and area surrounding the lids. The site of inflammation causes an uncomfortable sensation that can lead to pain.

It has been seen over the years that there is no single cause that results in eyelid dermatitis, instead there are several factors that are responsible for this condition. Eyelid dermatitis can result from atopic dermatitis, psoriasis, autoimmune conditions, irritants or allergens in the environment, seborrheic dermatitis, and just having dry eyeballs. When atopic dermatitis is the culprit there may be seasonal variation in the eyelid irritation [1].

Some of the types of dermatitis along with their causes, have been discussed below;

1) Allergen based

A product that you are using to take care of yourself or accessorize with may be to blame for the dry, scaly, and itchy eyelids you are experiencing.

The eyelids have skin which is thin and can very easily get damaged or irritated due to the use of chemicals. These chemicals are usually skin, hair and nail care products that stick to the skin of the eyelids and cause constant irritation and itchiness. Within one of those cosmetics there may be a fragrance, a preservative or a drying soap.

You could also have a piece of jewelry commonly worn that contains a metal that causes the problem.

The most common cause of eyelid eczema is due to allergic contact dermatitis [2]. It is worth explaining briefly. In “allergic contact dermatitis” (ACD) the body gets exposed to a molecule from the environment, like the metal nickel for example, and then when re-exposed the body makes a reaction to it 3-4 days later. This is opposed to an “irritant dermatitis” where upon contact the body gets irritation immediately.  It can be hard to flush out allergic contact dermatitis vs. irritant contact dermatitis, and may require the help of an allergist to do skin testing.

2) Airborne eyelid eczema

Airborne eyelid eczema is seen with the exposure of any irritant particle that is suspended in the atmosphere. Yep your job could be causing an irritation of your eyelids! In one case a factory worker, a chemist, making a commonly used anti-reflux medication developed scaly red eyelids, and patch testing proved that it was coming from the drug particles in the air [3]!

3) Seborrheic dermatitis

Seborrheic dermatitis is a chronic condition is often present on other parts of the body. It manifests as yellow scale on infants’ heads as cradle cap. It can cause redness and scale in the groin or armpits or on the sides of the nose and it can also cause scale and redness on the eyelids.

What are the symptoms seen with eczema on eyelids?

As mentioned above, atopic dermatitis is also a cause for eyelid dermatitis. Eyelid eczema can cause severe dryness, crusting, scaling, and even redness. It has been seen that eyelid eczema often presents in adults and teenagers, and is more rarely seen in children.

The most common symptoms seen with eyelid dermatitis are discussed as follows;

• Dryness- One of the most common symptoms associated with eczema on other parts of the body is dryness. This remains true for eyelid eczema as well. Cold and dry weathers often result in high incidences of eyelid eczema, especially in older people.
• Crusting- It has been seen that with dryness and irritation, some part of the skin loses its lustre and starts crusting and peeling.
• Scaling and fissures- Eyelid eczema may contain presence of scales and fissures at the eyelid margins.
• Lichenification of skin- Due to the constant rubbing, scratching and irritation, the folds of skin of the eyelid becomes thick and hard. This thickness of skin is also known as, “lichenification.”

A safe skin care regimen for eyelid dermatitis

The best strategy to avoid eyelid eczema is by using a shampoo for eczema and other body washes meant for people with eczema prone skin which avoid harsh soaps and do not contain common irritants like parabens or other preservatives or fragrances that can provoke allergic contact or irritant dermatitis.

There are many methods through which eyelid eczema can be managed. It is important not to apply harsh creams and lotions, instead it is better to apply eczema creams that are specifically for the treatment of eyelid eczema. A safe eczema cream will avoid common irritants like the preservative parabens that can irritate broken skin, and will not contain added scent and dyes. Regular and gentle application can help moisturize the skin of the eyelids and help maintain the protective skin barrier.

There are some people who apply corticosteroids in order to manage the process of inflammation, unless initiated by a physician this may invite a host of side effects and problems to their eye and eyelids.

References

1. Guin JD. Eyelid dermatitis: experience in 203 cases. J Am Acad Dermatol. 2002 Nov;47(5):755-65. doi: 10.1067/mjd.2002.122736. PMID: 12399770.
2. Amin KA, Belsito DV. The aetiology of eyelid dermatitis: a 10-year retrospective analysis. Contact Dermatitis. 2006 Nov;55(5):280-5. doi: 10.1111/j.1600-0536.2006.00927.x. PMID: 17026693.
3. Jurakić Tončić R, Balić A, Pavičić B, Žužul K, Petković M, Bartolić L, Ljubojević Hadžavdić S. Occupational Airborne Contact Dermatitis Caused by Omeprazole. Acta Dermatovenerol Croat. 2019 Sep;27(3):188-189. PMID: 31542064.

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Dr. Eddie Valenzuela

Dr. Eddie Valenzuela is an award winning pediatrician and the founder and CEO of Pediatric Solutions, LLC.

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