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Eyelid dermatitis : Causes, symptoms and treatment

closeup of eyelid dermatitis

If your eyelids itch, burn, turn red or get scaly, you may have a case of eyelid dermatitis, a non-contagious skin condition also known as eyelid eczema. When this kind of irritation occurs, there’s usually a strong instinct to rub or scratch your eyelids, an action that could endanger the surface of the eyes. 

The best thing to do is visit your eye doctor and figure out exactly what’s going on. Your eyelids are the only things standing between your eyeballs and the outside world, and you have to keep them healthy to protect your eyesight. 

The basics 

Your eyelids are complex mechanisms made mostly out of muscles, fat, nerves and blood vessels — all covered by a thin layer of skin called the epidermis. Dermatitis is the term for irritation of this outer skin layer. 

The skin on the eyelids is thinner than the skin on the rest of your body and it is filled with an abundance of blood vessels. These factors alone make the eyelids more prone to irritation than other areas of the body. 

To be even more specific, the fancy medical term for this irritation is periocular (or periorbital) dermatitis: “Perio” means “around” in Latin; ocular and orbital refer to the eyeballs and the eye sockets. 

Eyelid dermatitis symptoms

The symptoms of eyelid dermatitis are pretty basic: 

  • Itching

  • Burning

  • Swelling

  • Redness 

  • Flaky skin in the upper and lower eyelids and the area around the eyes

  • Thicker or creased-looking skin in the eye area 

Contact vs. atopic dermatitis

Eyelid dermatitis most commonly presents in two key varieties: 

Contact dermatitis 

In contact dermatitis, substances — liquid, solid or gas — can trigger contact dermatitis in the eyelids simply by touching them. Contact is most commonly made through: 

  • Irritants – Substances that trigger a change in the surface of the skin 

  • Allergens – Substances that set off an allergic reaction in the body’s immune system 

Atopic dermatitis

The most common form of eczema, atopic dermatitis does not require direct contact with allergens or irritants. Instead, it’s most likely the result of genetics and/or immune system dysfunction. When some substances get inside the body, they can trigger an allergic reaction that shows up on the skin in the form of dermatitis symptoms. 

SEE RELATED: Eye allergies: Get relief from itchy, watery eyes

Eyelid dermatitis causes

The ingredients in eyeliner and eyeshadow, along with the aromas used in some perfumes, are common causes of eyelid dermatitis flare-ups — times when symptoms appear worse than usual. 

The use of makeup could be one of the reasons about 80-90% of the people who get eyelid dermatitis are women. In addition to cosmetics, here are some of the most common triggers of eyelid dermatitis:

  • Soaps and detergents

  • Chemicals such as chlorine that get into the goggles of swimmers and divers 

  • Skin conditioners that cause burning or itching in sensitive skin

  • Noxious gases from industrial processes

  • Substances designed to dry out moist surfaces (sometimes called “hydrophobic,” which means they repel water) 

  • Extreme heat or humidity (both very high and very low levels of humidity)

  • Friction from rubbing and scratching the eyelids

  • Medications, such as neomycin, an antibiotic that cures skin infections caused by bacteria

  • Airborne fumes from air fresheners, nail polish, paint or glue 

  • Allergens including pollen, animal hair and dust mites

Note that this is only a partial list. Anything that irritates the skin, either through contact or allergic reaction, could conceivably cause a flare-up of eyelid dermatitis symptoms. 

How do doctors treat eyelid dermatitis?

Doctors usually don’t have much trouble reaching a diagnosis where eyelid dermatitis is concerned — the hard part is determining the underlying cause so they can start treatment.

But before that, doctors have to sort all of this out, starting with a patient history. That means tracking down as many facts as possible about your life, including your job, family, habits, home and friends. It’s crucial to tell your doctor as much as possible about yourself to ensure all possible triggers are ruled in or out. 

For example, if you already have sensitive skin, you’re more likely to get dermatitis. There might even be something in your genes that makes you more prone to a flare-up. Things like diet and exercise might also play a role. So, if you’re a jogger or a kick-boxer who does a lot of intense aerobic training and you have hay fever, you could be inhaling a lot of the allergen causing your outbreak. 

Another way for doctors to narrow down the cause of eyelid dermatitis is to have the patient apply a small amount of a suspected irritant (eye shadow, for example) on the forearm (or another section of sensitive skin) for several days. If dermatitis symptoms occur there too, the mystery is most likely solved.   

Trigger avoidance

Once the cause is determined, the treatment may be as simple as breaking off all contact with the substance causing the trouble. That means no eye makeup, for instance, until the dermatitis clears up.

Topical corticosteroids

But it’s not always that clear-cut. You may also need a treatment that includes medicines known as topical corticosteroids, which can help clear up inflammation in the short term. Your doctor may warn you that these treatments should not be used for the long term because they can have troublesome side effects. 

Topical cream

Your doctor may also recommend a topical eyelid dermatitis cream that may be less effective than corticosteroids but have fewer side effects. 

What are the best ways to prevent eyelid dermatitis? 

Most cases of eyelid dermatitis clear up after around 30 days of treatment, and once an outbreak has subsided, prevention may be as simple as avoiding the irritants that caused the initial problem. 

Here are some tactics for avoiding eyelid dermatitis in the future:

  • Resist the urge to rub or scratch your eyelids. 

  • Avoid touching your eyelids with dirty hands or fingers — they may have irritants on them. 

  • When washing your face (especially in the eye area), use clean water or a cleansing cream made for sensitive skin.

  • Wear eye protection (such as wraparound goggles or glasses) to keep irritants away from your eyelids.

Ask your doctor for brochures or other information about preventing eyelid dermatitis from returning. 

Does eyelid dermatitis require a doctor’s visit? 

If you notice that new soap or makeup seems to make your eyelids red or itchy, stop using it immediately and see if the irritation clears up. That could be all there is to it. 

Unfortunately, many cases are harder to resolve because the cause isn’t so clear. If you think you’re experiencing symptoms of eyelid dermatitis, contact an eye doctor for proper assessment and treatment.

Anything that creates discomfort in your eyelids is going to make your life unpleasant, so it’s a good idea to set up an appointment if eyelid dermatitis, or any other condition, has started bothering you or affected your vision.  

SEE RELATED: Itchy eyes: Causes and cures

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