Contact dermatitis of the eyelid is an allergic reaction of the eyelid skin to certain sensitizing agents. It can also be part of a broader allergic reaction involving the skin of the head and face, with drug-induced dermatitis being the most typical form. Common sensitizing agents include topical antibiotics, local anesthetics, atropine, pilocarpine, iodine, and mercury-containing preparations. Notably, sensitizing agents such as atropine or pilocarpine eye drops may cause symptoms after a period of exposure. Other chemicals, such as cosmetics, hair dyes, medical adhesive tapes, contact lens solutions, and eyeglass frames, may also act as allergens. Systemic exposure to certain allergens or specific foods can cause similar symptoms.
Clinical Manifestations
Symptoms include itching and a burning sensation around the eyes. Acute forms present with sudden onset of eyelid redness and swelling, accompanied by papules, vesicles, or pustules on the skin, along with slightly yellow, viscous exudate. Over time, erosion, crusting, and desquamation (skin peeling) occur. In some cases, eyelid conjunctiva thickening and hyperemia are observed. Subacute forms are characterized by slower onset and a more prolonged course. Chronic forms may evolve from acute or subacute eczema, leading to thickened, rough eyelid skin with surface scaling and lichenification.
Diagnosis
The diagnosis is typically based on a history of exposure to sensitizing agents and eczematous changes in the eyelid skin. Patch testing can be performed to differentiate between allergic and irritant contact dermatitis.
Treatment
Avoidance of sensitizing agents is key. If the allergen cannot be identified due to simultaneous use of multiple medications, temporary discontinuation of all medications may be necessary.
During the acute phase, wet compresses with physiological saline or a 3% boric acid solution can be applied. Glucocorticoid eye drops may be instilled into the conjunctival sac. Once exudation from the eyelid skin subsides, glucocorticoid eye ointments may be applied.
Systemic antihistamines can be administered. In severe cases, oral corticosteroids may be required.