The delicate nature of eyelid skin presents challenges—it's more susceptible to irritants and triggers and at greater risk of adverse effects from topical steroids. This can be further exacerbated by the use of cosmetic and personal care products.
Eyelid eczema
July 5, 2023
Eczema on the eyelids – Causes, symptoms and treatment for eczema around the eyes
Eyelid eczema and eczema around the eyes are relatively common conditions which affect the eyes typically causing redness, dryness, itching, swelling, irritated skin and thickening of the eyelids and periorbital skin (skin around the eyes). The terms eczema and dermatitis do not refer to a specific cause but instead, refer to the inflammation occurring with the skin. When people refer to eczema they often mean atopic dermatitis a specific type of eczema which is triggered via genetic weakness in the skin barrier and dysregulated inflammation.
The delicate nature of eyelid skin poses specific challenges as the skin is subsequently more susceptible to external irritants and triggers. This is compounded by the common use of cosmetics and personal care products where the skin is exposed to various chemicals that have the potential to trigger inflammation. This delicate skin structure also makes the area more susceptible to the adverse effects of topical steroids - one of the most important treatments in eczema management.
The psychological impact of eczema around the eyes is also important to recognise, the eyes are significant areas of aesthetic interest and can't easily be hidden unlike other body regions - this can lead to a vicious cycle where individuals are driven to use cosmetic products to conceal their eczema only to further exacerbate their flares.
In this article, we will discuss eczema on the eyes, eczema under the eyes, the various possible underlying causes, and how to manage the condition. We'll also explore the best eye creams for eczema on the eyelids (prescription and OTC) and how to avoid triggers.
What conditions affect the eyelids?
The eyelids are a crucial part of the eye, providing protection and moisture to the delicate organ. Various conditions can affect the health and function of the eyelids, leading to discomfort, itchiness and potential vision issues.
Atopic dermatitis on eyelids
Atopic dermatitis (Atopic eczema, AD), also known as eczema, is a chronic skin condition characterised by dry skin, which is susceptible to inflammation and irritation. It is driven by a genetic weakness in the skin barrier, leading to dryness a weakened skin barrier and increased susceptibility to environmental triggers and irritants. The condition typically develops in childhood and affects the skin creases, elbows, knees, hands, and eyelids. Given the condition is caused by genetic factors there may be a family history of eczema or other atopic conditions (asthma, hayfever and food allergies). The condition tends to follow a chronic path with periods of flare-ups and remission. Though there is an association between atopic dermatitis and allergies atopic dermatitis tends not to be triggered by direct contact with an allergen but instead is driven by allergen exposure elsewhere on the body (ie the inhalation of dust or pollen). Atopic dermatitis typically causes itchy skin, but on the face and eyelids, it often causes soreness and discomfort. The key diagnostic features of this condition include childhood development, skin fold/crease involvement, a history of other allergy-related conditions (such as hay fever, asthma, and food allergies), and the chronic (relapsing/remitting) nature of the condition.
Contact dermatitis on eyelids
Unlike AD which is caused by genetic factors, contact dermatitis on the eyelids occurs when the skin comes into direct contact with an irritant or allergen, leading to skin inflammation and irritation.
Contact dermatitis can be broken down into two main groups: allergic contact dermatitis and irritant contact dermatitis. It is impossible to differentiate AD from contact dermatitis based on symptoms alone meaning establishing the underlying diagnosis of skin dermatitis is complicated to establish. This is further complicated by the fact that all of these conditions can co-exist together. The key to establishing the underlying cause is based on the history of how the condition developed, how it is responding to treatment and the areas of skin affected.
Allergic contact dermatitis
Allergic contact dermatitis occurs when the skin comes into direct contact with an allergen, a substance that causes allergies. The delayed onset of this allergic reaction can complicate the identification of the exact cause. In contrast to immediate allergic reactions, which manifest within minutes or hours of exposure to an allergen, symptoms of allergic contact dermatitis may take days to emerge. Common allergens include nickel, latex, and certain chemicals present in cosmetics, soaps, and dyes. Due to the delayed nature of the reaction, diagnosing allergic contact dermatitis often necessitates a comprehensive medical history, including details about recent exposures, and patch testing to pinpoint the specific allergen responsible for the reaction. Indications that allergic contact dermatitis may be the cause include the affected areas of the skin (with hands and face being most susceptible), the pattern of the condition (newly affected areas), and its limited response to standard treatments. Once the allergen is identified, the most effective course of action is to avoid future exposure to it.
Irritant contact dermatitis
Irritant contact dermatitis occurs when the skin is directly irritated by physical or chemical agents. Physical irritation can be caused by friction, such as rubbing or scratching the skin. Chemical irritation can be caused by exposure to substances such as household cleaners, soaps, detergents, or solvents. These substances can disrupt the skin's barrier function, leading to inflammation and irritation.
The severity of irritant contact dermatitis can vary depending on the intensity and duration of the exposure to the irritant. Symptoms may include redness, swelling, itching, and a burning sensation in the affected area. In more severe cases, blisters and cracked skin may develop.
Previously weakened skin such as that seen in atopic dermatitis is more susceptible to irritant exposure, increasing the risk of irritant contact dermatitis developing. Irritant contact dermatitis can usually be identified through the history alone and there are no specific tests required to make the diagnosis.
Blepharitis
Unlike the other conditions mentioned above which can affect skin anywhere on the body, blepharitis only affects the eyelids. The exact cause of blepharitis is not fully understood, but it is commonly associated with bacterial overgrowth, blocked oil glands near the base of the eyelashes, and certain skin conditions such as rosacea.
The symptoms of blepharitis include red, swollen and itchy eyelids, a gritty or burning sensation in the eyes, crusting or flakes at the base of the eyelashes, excessive tearing, and blurred vision. Individuals with blepharitis may also experience sensitivity to light and the feeling of having something in the eye.
What does eczema on the eyelids look like?
The appearance of atopic and contact dermatitis on the eyelids looks similar and it is impossible to differentiate the underlying cause from the appearance alone. The typical appearance is of inflammation which may present as small bumps, red or discoloured patches, swelling or weeping. During periods of inflammation the skin barrier is weakened increasing the skin's susceptibility to infections, infected skin will typically have a crusted appearance which may be golden or yellow.
The appearance of eczema on the eyelids can differ depending on the skin tone of the individual. In people with lighter skin tones, the affected area may appear red or pink with noticeable bumps, while in individuals with darker skin tones, eczema can cause the skin to become lighter or darker than the surrounding skin. In both cases, the skin may become rough, scaly or thickened if left untreated for prolonged periods.
What are the symptoms of dermatitis and eczema on the eyelids?
Dermatitis and eczema on the eyelids can cause a variety of uncomfortable symptoms that can impact eye health. Common symptoms include itching, stinging, soreness, and weeping.
Itching is a common symptom of both atopic and contact dermatitis on the eyelids. This persistent itching can be very uncomfortable, it is crucially important to avoid itching the skin at all costs as this can lead to further skin damage and irritation. Stinging and soreness are also frequently experienced, making it painful to blink or close the eyes. Additionally, the sensitive skin of the eyelids is more prone to becoming swollen and may lead to weeping, or the discharge of clear fluid from the skin.
It is important to seek medical attention if you are experiencing these symptoms, as untreated dermatitis and eczema on the eyelids can lead to complications such as infection, skin thickening and discolouration.
What triggers/exacerbates eye eczema?
As described above the trigger of eye eczema depends on the underlying cause.
For atopic dermatitis, triggers tend to fall into two categories - things that further weaken the skin and things that directly trigger inflammation. Given that dryness and water loss from the skin are one of the key factors of AD anything that exacerbates this can trigger the skin, this includes exposure to dry conditions, cold weather, air conditioning etc as well as things that pull moisture out of the skin such as cleansers and soaps. Things that directly trigger inflammation in the skin include soaps and cleansers, makeup, feathers, and dust. The skin around the eyes is particularly delicate, and can easily flare if exposed to any of the above.
In the case of contact allergies, specific substances trigger the inflammation. These triggers can be identified through analysis, for irritant contact dermatitis the cause can usually be identified by taking a thorough history, while for allergic contact patch testing is often required to identify the cause. Patch testing involves applying small amounts of different potential allergens to the skin and then observing for any adverse reactions. Through this testing, the specific substances that trigger eye eczema can be pinpointed, allowing for avoidance and management of these triggers.
Treating eczema on eyelids
Eczema on the eyelids can be uncomfortable and irritating. The delicate skin around the eyes requires gentle and targeted treatment to manage and alleviate symptoms effectively. From identifying triggers to adopting a suitable skincare routine, there are specific measures that can be taken to effectively treat eczema on the eyelids. Understanding the condition and implementing the right strategies is crucial for individuals seeking relief from this common skin problem.
Moisturisers
Moisturisers are the most important part of eczema/AD management. Because they are available over-the-counter and don't need a prescription they are often undervalued by eczema sufferers but they are crucial tools that can help both restore the skin's strength, soothe itch and prevent flares. Moisturisers are topical treatments which come in various forms from lotions (lightest) to creams and ointments (heaviest). Lotions have the least oil content making them easily absorbable, easy to apply and light feeling, they also need to be applied regularly and have little occlusive function (moisture locking). Ointments are the heaviest and have high oil content making them slow to absorb, harder to apply and heavy feeling, they are very good at locking in moisture and don't need to be applied regularly. Moisturisers help relieve dryness and itching.
For eyelid use, it is seldom necessary to use ointments due to the delicate nature of the eyelid skin. Generally, lotions can be used during the daytime, while heavier creams are applied at night.
It's important to avoid using any perfumed moisturisers and we'd recommend sticking to products specifically designed for sensitive or eczema-affected skin such as Aveeno, Cetraben, CeraVe, and La Roche-Posay.
Steroids
Topical steroids are commonly prescribed to treat various skin conditions such as eczema, psoriasis, and dermatitis. They work by suppressing the skin's immune system, reducing inflammation and allowing the skin barrier to be restored. They are crucial tools in tackling inflammation and should be used as circuit breakers to tackle flares alongside regular moisturiser use.
When using steroid creams, it is important to choose the appropriate potency. Only the weakest potency steroids (hydrocortisone) are safe to be used on the eyelids due to the delicate nature of the skin in this area. Use on the eyelids should be time-limited as even with the mildest potency products prolonged use can lead to side effects.
Potential side effects of using topical steroids include thinning of the skin, increased visibility of small blood vessels and discolouration. Inappropriate use can lead to topical steroid withdrawal (also known as topical steroid withdrawal syndrome or topical steroid addiction). It is essential to strictly follow a doctor's instructions for their use and to only use them for the prescribed duration.
Topical Calcineurin Inhibitors
Topical calcineurin inhibitors, are another group of medications that can be used to tackle inflammation. They have a different mechanism or action to steroids and aren't associated with the same adverse effects. They are particularly useful in areas of the skin at risk of steroid side effects (the eyelids) and can be used to either limit steroid use or avoid steroid use entirely.
Because they don't cause the same side effects as steroids they can be used for both prevention and the management of acute flares of eyelid eczema.
Topical calcineurin inhibitors can cause burning or itching at the application site, this tends to settle over time. They also increase sun sensitivity and therefore you should avoid excessive sunlight exposure while using these medications. Overall, they are a valuable treatment option for eyelid eczema due to their ability to effectively manage symptoms and reduce the need for steroids, which may have their own set of side effects with long-term use.
Home remedies
Home remedies for eye eczema can help reduce symptoms and soothe the affected area. A cold compress can be used to reduce itching and swelling. Simply apply a clean, damp cloth to the eyes for a few minutes to provide relief.
However, it is important to consult a doctor for severe symptoms, as they may require medical treatment.
Avoiding triggers
Atopic dermatitis flare-ups can be triggered by various physical and allergen factors. Physical triggers can include excessive heat, dry air, sweat, and rough or irritating fabrics like wool. Possible allergen triggers may include airborne allergens such as pet dander, pollen and dust mites. Personal care products and cosmetics can also directly trigger inflammation and weaken the skin barrier. For individuals prone to eczema flare-ups, it is advisable to use fragrance-free products to minimise the risk of irritation.
Common allergens associated with allergic contact dermatitis include nickel, fragrances, hair dye, and certain preservatives found in skincare products. If your doctor suspects you have a contact allergy you will likely need to have patch testing to identify the cause.
General practical tips for minimising exposure to triggers include using gentle, fragrance-free skin care products, regularly washing bedding and clothing to remove allergens with an extra rinse setting to remove residue chemicals, and avoiding extreme temperatures and excessive sweating. Additionally, creating a comfortable and allergen-free environment within the home by investing in hypoallergenic bedding and air purifiers can also aid in minimising flare-ups.
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