From the Guidelines
Treatment for eyelid eczema should prioritize gentle skincare and appropriate medications, with a focus on warm compresses, eyelid cleansing, and topical anti-inflammatory agents, as recommended by the most recent study 1.
Key Components of Treatment
- Warm compresses to soften adherent scurf and scales or discharge and/or warm the meibomian secretions
- Eyelid cleansing, including eyelid massage in cases of meibomian gland dysfunction (MGD) to express the meibomian glands
- Topical anti-inflammatory agents, such as corticosteroids or cyclosporine
- Identification and avoidance of potential triggers, such as makeup, skincare products, or environmental allergens
Treatment Approach
The optimal treatment regimen often requires persistence and a trial-and-error approach, with an initial step of recommending warm compresses and eyelid cleansing, which may be accomplished in several ways 1.
Medications and Skincare
For mild cases, over-the-counter 1% hydrocortisone cream can be applied sparingly to the eyelids once or twice daily for up to 7 days. For more severe cases, a doctor may prescribe a low-potency topical steroid like desonide 0.05% or a non-steroidal immunomodulator such as tacrolimus 0.03% or pimecrolimus 1% cream 1.
Additional Considerations
Eyelid skin is very thin and absorbs medications readily, so all treatments should be used sparingly to avoid side effects. If symptoms don't improve within two weeks or worsen at any point, consultation with a dermatologist for further evaluation is recommended 1.
From the Research
Treatment Options for Eyelid Eczema
- Topical corticosteroids are commonly used to treat inflammatory skin conditions, including eczema 2
- The potency and formulation of topical corticosteroids can vary, and the choice of treatment depends on the severity and location of the eczema 2
- For eyelid eczema, tacrolimus ointment 0.1% has been shown to be a safe and effective treatment option, with significant improvement in symptoms and no increase in intraocular pressure 3
Efficacy of Different Treatments
- A network meta-analysis of 291 studies found that potent and very potent topical steroids, tacrolimus 0.1%, and ruxolitinib 1.5% were among the most effective treatments for improving patient-reported symptoms and clinician-reported signs 4, 5
- Pimecrolimus cream was found to be less effective than topical corticosteroids and tacrolimus 0.1% in some studies 6
- The efficacy of different treatments can vary depending on the severity and location of the eczema, as well as individual patient factors 4, 5
Safety and Adverse Effects
- Topical corticosteroids can cause adverse effects such as skin thinning, especially with long-term use 2, 4
- Tacrolimus 0.1% and crisaborole 2% were found to be more likely to cause local application site reactions, while topical steroids were less likely to cause these reactions 4, 5
- The risk of adverse effects can be minimized by using the lowest effective dose and potency of topical corticosteroids, and by monitoring patients for signs of adverse effects 2