Eczema of the eyes and eyelids: how to treat it?

The eyelids, whose skin is very thin, are particularly sensitive to irritating substances and certain allergens. They react easily to their contact.

Eczema of the eyes and eyelids: what symptoms?

In general, an eczema flare-up goes through four phases. The inflammation lasts longer or shorter depending on the person. Faced with itching, you must avoid rubbing your eyes at the risk of seeing the situation worsen.

1- At first, the eyelids may swell.

2- Then, red plaques appear. They itch badly. There may be small weeping, then crusty blisters.

3- The skin becomes drier and cracks. We see small streaks appear. The itching is still present.

4- Finally, the skin heals and the plaques disappear without leaving a mark.

Eczema of the eyes and eyelids: what are the causes?

These red patches that appear on the eyelids can have several origins, often intertwined.

atopic eczema

This type of eczema, also called atopic dermatitis, usually appears in childhood. It develops in genetically predisposed people whose skin is particularly reactive. Eczema patches most often affect both eyelids simultaneously, but they also affect other areas of the body such as the elbow creases and the popliteal fossae (back of the knees).

Contact eczema

The reaction may be related to a irritating substance repeatedly coming into contact with the eyelids. It may be, for example, a make-up remover or a detergent. In general, there are no lesions on other areas of the body.

The reaction may also be due to a allergenic molecule (e.g. eye shadow) brought into contact with the eye, eyelid or nearby skin. Eczema usually appears 24 to 72 hours later.

Some nail polish semi-permanent may be involved. They contain, in fact, potentially allergenic acrylates. It is enough, then, to touch the eyes with the hands to trigger the reaction. In this case, we can find eczema around the nail.

The eyelids can also become inflamed on contact with day cream, shampoo or hair dye. In this case, the patches of eczema also affect the face or the scalp.

The perfumes are often incriminated. Logically, we often find a patch of eczema not only near the eye, but also behind the ear, on the neck or on the wrist: the areas where we put a drop of perfume.

Sometimes the simple act of wearing earrings nickel, an allergenic metal, can affect the eyes. In case of nickel allergy, the person often notices a patch of eczema next to the button of his pants.

Among the molecules frequently found in contact eczema of the eyelids, a preservative called methylisothiazolinone is often singled out. “For two years, it has now been banned in cosmetics that cannot be rinsed off. But it is still found in shampoos, dishwashing products, washing powders or detergents. When it is present in paintings, it is released into the air for several weeks”, observes Dr. Boulard.

Another allergen to think about: eye drops applied directly into the eye. The reaction can be linked either to the active ingredient or to the presence of preservatives. Most often, eczema will affect more the inner edge of the eye or the lower eyelid. This type of reaction is often accompanied by conjunctivitis, ie inflammation of the white of the eye, which then turns red. In case of conjunctivitis, we must also think of an allergy to pollens or dust mites.

Only tests carried out by an allergist can determine the molecule(s) responsible for the allergy. Test patches (small “stamps” each containing an allergen) are placed on the patient’s back and removed after two or three days. The result is known in two to seven days. “Do not throw away products that you suspect may be causing the allergy. They can be tested and their composition can help us identify the allergen,” recalls Claire Boulard. These test patches can be supplemented by other examinations, if necessary (prick tests or test of repeated applications).

Once the allergen has been identified, the dermatologist gives the patient an avoidance sheet which tells him which products contain the substance he should avoid. Advice is also given to learn how to decipher the labels and the composition of each product. You can also use smartphone applications like Allergobox or Yuka.

Factors that can make eczema around the eyes worse

It is better to avoid rubbing your eyes so as not to risk aggravating the inflammation. “Rubbing can also cause small cuts which are entry points for infections,” warns Dr. Boulard.

Similarly, avoid exposure to tobacco smoke, air fresheners and, as far as possible, pollution, which only irritate the eyes a little more.

Eczema of the eyes and eyelids: what treatments?

To prevent an allergic reaction from occurring again, the best (and most logical) solution is to avoid all contact with the allergen, once it has been identified.

Second tip: hydrate as much as possible the skin. There are emollient creams specially formulated for sensitive eyelids (SVR, La Roche Posay, Ducray, Eye Care, etc.).

What cream can be prescribed?

To combat inflammation, the dermatologist prescribes a cortisone cream. “As the eyelids are a fragile area, we choose a low-class topical corticosteroid, in a short course of a few days”, explains Claire Boulard. This treatment is very effective. It eliminates inflammatory plaque and itching in a short time, provided it is applied at the dose and for the duration prescribed by the dermatologist. The notion of duration is important. “The treatment must be punctual and short”, recalls the dermatologist who underlines the risk of side effects in the event of repeated and too frequent applications: superinfection, rosacea, glaucoma, cataracts…

What other drugs?

If the lesions persist despite the topical corticosteroid cream, the dermatologist has another weapon: the tacrolimus as an ointment, to be applied once or twice a week, until the eczema disappears.

Finally, in case of atopic dermatitis, other more specific treatments are proposed. “These are systemic treatments that treat the whole body, including eye injuries. They are taken either by mouth or by injection. says the dermatologist. It is very important to properly manage this atopic eczema because if the inflammation persists in the eye, there is a risk of kerato-conjunctivitis, or even keratitis (inflammation of the cornea).

Daily solutions to protect your eyes

Once the eczema has been treated, women who wish can continue to make up their eyelids and eyelashes, provided they choose suitable cosmetics (without alcohol, perfumes or preservatives).

For good eyelid hygiene, compresses soaked in physiological saline or thermal water or cornflower water can be applied, taking care to dab. Above all, do not rub. Here again, we forget products containing alcohol, preservatives or perfumes which are far too irritating.

Finally, to protect and rest your eyes, and all the more so when eczema is associated with conjunctivitis, wearing sunglasses is strongly recommended.

What about natural care for eye eczema?

“Beware of “organic” cosmeticsanswers the dermatologist. Organic doesn’t mean they don’t contain allergens. As for essential oils, they can be allergenic, especially since the eyelid area is very thin. »

On the occasion of National Eczema Day, Saturday June 4, 2022, the French Eczema Association is organizing conferences in different cities and launching the “Stop scratching yourself” campaign. More info on www.associationeczema.fr. Remember that more than 2.5 million French people suffer from atopic dermatitis.

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