What is eczema around the eyes?
Eyelid eczema is common and may be confined to the eye area or form part of more widespread eczema. It can be especially distressing because it is visible and because both eyelid skin and the eyes are vulnerable, limiting which treatments can be used safely.
Possible causes
- Atopic eczema is the most frequent cause. It can occur at any age, often beginning in childhood, fading and sometimes returning in adulthood. No direct trigger is found in many cases.
- Allergic contact eczema may follow mascara, other cosmetics, shampoo, conditioner or cleansers. An allergen can be transferred from the hands by rubbing; it may affect delicate eyelids without causing a hand rash.
- Airborne allergens such as pollen or house-dust mites may irritate itchy eyelid margins, often with red, watering eyes.
- Seborrhoeic eczema usually also affects the hairline, eyebrows or folds beside the nose; disease limited to the eyelids is uncommon.
- Irritant eczema can follow harsh cleansing products or repeated rubbing. Chronic rubbing may thicken and coarsen the skin, called lichenification.
Diagnosis
Irritant and seborrhoeic patterns may be recognised from their distribution and exposures. Atopic and allergic contact eczema can look alike, so a dermatologist may perform patch tests. If no relevant allergy is found, atopic eczema may be the most likely diagnosis.
Treatment
Avoiding an identified allergen or irritant should improve the rash. Topical corticosteroids suppress all types of eczema, but prolonged or excessive use can thin eyelid skin and may increase the risk of glaucoma and cataracts. Only a relatively mild product should be used for a short period around the eyes and exactly as prescribed.
Tacrolimus or pimecrolimus can reduce inflammation without thinning the skin and are particularly useful for atopic eczema. Stinging, itching and greater redness may occur during the first days, then usually settle. Use a simple emollient with as little fragrance and preservative as practical; tar preparations are generally avoided on the face.
When to see a doctor
Seek medical advice for persistent or recurrent eyelid eczema or before using medicated cream near the eyes. Obtain urgent assessment for eye pain, light sensitivity, visual change, severe swelling, pus, spreading redness or fever.