Eyelid Dermatitis - Symptoms, Causes & Treatment

What is Eyelid Dermatitis (Eczema)?

Eyelid dermatitis, also called eyelid eczema and periocular dermatitis, is inflammation on the folds of the eyelid caused by an allergen or irritant, resulting in itchy, red, and scaly skin. 

Eyelid eczema develops when a person’s immune system reacts to a chemical or antigen that touches the skin, triggering an overactive immune response and inflammation. 

It is estimated that 20% of the general population is affected by contact dermatitis, including eye dermatitis, making it a common skin condition for children and adults.² 

Finding the cause and environmental triggers of eyelid dermatitis is the first step in treating periorbital dermatitis. It can be challenging and requires an elimination approach. 

Symptoms of Eyelid Dermatitis

Since the eyelids are thin and delicate, they are susceptible to allergens and irritants. Eyelid dermatitis affects the upper and lower eyelids of either one or both eyes. 

Common symptoms of eyelid dermatitis include:

• Redness
• Itchy rash
• Scaly skin
• Burning or stinging sensation 
• Swelling and inflammation
• Thickened skin
• Dry, cracked skin
• Irritated skin

Types of Eyelid Dermatitis & Their Causes

There are various types of eyelid dermatitis depending on what substance is causing the immune response and skin inflammation. The most common types of eye eczema include irritant contact dermatitis, allergic contact dermatitis, seborrheic dermatitis, and atopic dermatitis.

Irritant contact dermatitis

Irritant contact dermatitis occurs when an irritating substance causes damage to the outer layer of the skin. It does not involve the immune system. 

Common irritant triggers that cause contact dermatitis include:

• Laundry detergents
• Soaps 
• Solvents (nail polish remover)
• Clothing material 
• Household cleaners 
• Body fluids (sweat and saliva)
• Paint
• Certain plants
• Heat and sweating
• Latex
• Fragrances 
• Nickel
• Facial creams
• Sunscreen
• Hair dye

Symptoms of irritant eyelid contact dermatitis typically include:

• Burning
• Itching 
• Pain
• Dry fissured skin

Allergic contact dermatitis

Allergic contact dermatitis is an allergic reaction to a substance that triggers a hypersensitive immune response resulting in inflammation and an itchy rash. 

Common triggers of allergic contact dermatitis include:

• Fragrances
• Metal (especially nickel)
• Plants, such as poison ivy and poison oak
• Medication and antibiotics
• Leather
• Latex rubber
• Hair dyes
• Citrus fruit
• Lotions and makeup (eye shadow)

Symptoms of allergic eyelid dermatitis include:

• Red eyelid skin
• Extreme itchiness
• Hives
• Rash
• Oozing blisters
• Dry, flaky, scaly skin

Atopic dermatitis 

Atopic eczema is a chronic (long-lasting) skin condition caused by an overactive immune response, environmental triggers, stress, and genetics. Unlike other types of dermatitis, atopic eczema is not caused by one thing. There is no cure for atopic dermatitis.

Atopic dermatitis affects 1 in 10 Americans and is prevalent among children. Eczema flare-ups can lead to sleepless nights, low self-esteem, and depression.⁹

Common causes of atopic dermatitis around the eyes include:

• Family history of eczema
• History of food allergies and asthma
• Stress
• Overheating/sweating
• Harsh soaps, detergents, and cleansers
• Exposure to tobacco smoke and air pollution
• Low humidity 

Similar to contact dermatitis, atopic eczema starts with extreme itching followed by:

• Dry, flaky skin
• Redness 
• Skin inflammation
• Rash
• Bumps on skin
• Swollen eyelids
• Crusting on the eyelids

Seborrheic dermatitis

Seborrheic dermatitis reacts to a type of yeast naturally on the skin. Seborrheic dermatitis is often associated with the scalp (a cause of dandruff and cradle cap) but can also affect the eyelids. 

Seborrheic dermatitis is triggered by hormones and various health conditions, including:

• HIV
• Neurological disorders (Parkinson’s disease, traumatic brain injury)
• Epilepsy
• Hepatitis C virus
• Down syndrome

Eyelid symptoms caused by seborrheic dermatitis include:

• Red or pink rash
• Greasy-looking skin
• White flakes
• Itchiness
• Burning sensation
• Darkening of the skin

Risk Factors for Eyelid Dermatitis

Eyelid dermatitis frequently runs in families and can happen at any age. However, certain factors can increase your risk of developing eyelid dermatitis, including:

• Age, infants and children are susceptible to atopic and seborrheic dermatitis
• Health conditions such as asthma, food allergies, and hay fever 
• Genetics and a family history of eczema 
• Poor hygiene, which can lead to eyelid inflammation and infection
• Specific jobs that handle chemicals and harmful substances 
• Medications including NSAIDs, antibiotics, and antifungal medicine 

When to See a Doctor

While eyelid contact dermatitis typically resolves when the environmental trigger is removed, atopic and seborrheic dermatitis is chronic, with flare-ups coming and going.  

It is essential to seek medical care from a dermatologist or primary care doctor if eyelid dermatitis symptoms are affecting the quality of life, including:

• Blurred vision 
• Yellow or green discharge (signs of infection)
• Crustiness around the eyes when you first wake up (signs of pink eye)
• Symptoms don’t resolve with over-the-counter treatment
• Eye pain
• Light sensitivity
• Any changes in vision 

Diagnosis 

Eyelid dermatitis is diagnosed by a primary care physician, dermatologist, allergist, or eye specialist. 

They will take a detailed medical and family history during the appointment and ask you about symptoms. It is good to write down or keep track of flare-ups and possible triggers to discuss with the doctor.

Various skin tests diagnose eyelid dermatitis and determine what type of eczema is causing symptoms. Standard skin tests include:

• Skin patch test. This involves placing patches containing common allergens on arms or back to look for signs of inflammation.
  
• Skin prick test. A tiny needle containing common allergens lightly scratches the back to look for signs of inflammation.
  
• Intradermal test. A small amount of allergen is injected into the skin to see if it causes allergic reactions.
  
• Radioallergosorbent (RAST) test. This uses a blood sample to check for antibodies that confirm you are having an allergic reaction to a substance.

Treatment

The first goal of treating contact eyelid dermatitis is to eliminate the allergen or irritant causing symptoms. 

Additional goals of eyelid dermatitis treatment include:

• Decrease inflammation
• Ease itching and pain
• Keep skin moist and hydrated
• Prevent infection 

Gentle skin care, medication, and trigger management are the gold standard in treating eyelid dermatitis. 

Common treatments for people with contact and atopic eyelid dermatitis include:

• Topical medication including corticosteroid cream, coal tar, crisaborole, or pimecrolimus ointment
• Skin care routine that includes bathing, moisturizer, using products designed for sensitive skin, and a cold compress on the eyes
• Trigger management with a doctor to identify, eliminate, and avoid environmental allergens and irritants
• Phototherapy using ultraviolet light to minimize dermatitis symptoms
• Oral medication prescribed by a doctor to reduce immune response and relieve symptoms

Complications 

If left untreated, eyelid eczema can affect the quality of life and lead to poor health outcomes, including:

• Severe eye infection that can lead to blindness
• Skin infections
• Scarring of the eyelids
• Blisters
• Depression
• Anxiety
• Low self-confidence
• Difficulty sleeping

Prevention

While it may be challenging to get rid of eyelid eczema completely, there are ways to prevent and minimize symptoms while managing the itch-scratch cycle, including:

• Avoid touching your eyes and face
• Limit eye makeup and cosmetics
• Use an over-the-counter anti-itch cream
• Moisturize your skin while it is still wet after bathing
• Reduce stress
• Avoid the heat and activities that make you sweat
• Use gentle skin care products designed for sensitive skin
• Apply a warm compress to your eyes 
• Wear protective eyewear  

Outlook

Eyelid dermatitis flare-ups are painful, irritating, and inconvenient. However, topical medication, trigger management, and a consistent skin care routine can minimize symptoms and help prevent flare-ups. 

Working with a licensed dermatologist is key to getting eyelid dermatitis under control.

Summary

Eyelid dermatitis is a common form of eczema resulting in inflammation of the eyelids. It can be caused by allergens, irritants, genetics, and health care conditions such as asthma and food allergies. Symptoms include itchiness, rash, burning, and scaly skin.

Pinpointing and eliminating triggers is the goal of treating contact dermatitis. Treatment includes a combination of a gentle skin care routine, trigger management, and topical medications. Working with a dermatologist or allergist can help you customize a successful treatment plan.