From the Guidelines
Eczema around the eyes should be managed with gentle lid hygiene measures, including the application of warm compresses to the closed eye, followed by eyelid massage and cleaning of the eyelid margins with homemade bicarbonate solution or commercially available lid wipes, as recommended by the British Journal of Dermatology in 2024 1. When managing eczema around the eyes, it is essential to consider the potential for dry eye and blepharitis, and to promote healthy tears to lubricate the eyes and reduce inflammation.
- Avoid using flannels soaked in hot water due to the risk of scalding, and instead use specially designed, battery-powered devices or microwaveable eyelid warming devices.
- Eyelid massage and cleaning of the eyelid margins can help to soften the oils and unblock the oil glands, reducing the risk of infection and promoting healthy eyelid function.
- For patients with persistent facial and eyelid eczema, patch testing may be considered to identify potential allergic triggers, although the role of patch testing in the management of dupilumab-related ocular surface disorders is unclear 1. In terms of pharmacological management,
- dupilumab dose reduction may be a useful approach in selected patients with good skin control, as it may reduce the risk and severity of ocular adverse events, with a study showing improvement in DROSD symptoms in 47% of cases 1.
- other systemic therapies, such as upadacitinib, abrocitinib, and baricitinib, may be recommended for adults with moderate to severe atopic dermatitis, although their use in patients with eczema around the eyes is not specifically addressed in the guidelines 1.
From the FDA Drug Label
Do not use ELIDEL Cream in the eyes. If ELIDEL Cream gets in your eyes rinse your eyes with cold water. The FDA-approved use of pimecrolimus cream does not include application around the eyes. Eczema around the eyes should not be treated with ELIDEL Cream. If the cream accidentally gets in the eyes, they should be rinsed with cold water. 2
From the Research
Eczema Around the Eyes
Eczema around the eyes can be a challenging condition to manage due to the sensitive nature of the skin in this area.
- The use of topical anti-inflammatory treatments is a common approach to controlling eczema symptoms, including around the eyes 3, 4.
- Topical corticosteroids (TCS) are often used as a first-line treatment for eczema, but their use around the eyes requires caution due to the risk of adverse effects such as skin thinning and glaucoma 5.
- Tacrolimus ointment, a topical calcineurin inhibitor, has been shown to be effective in treating atopic dermatitis, including around the eyes, with a lower risk of skin thinning compared to TCS 6, 7.
- However, the use of tacrolimus around the eyes may cause local application-site reactions, such as burning and stinging, although these symptoms are usually mild and transient 6, 4.
Treatment Options
The choice of treatment for eczema around the eyes depends on the severity of the condition and the individual's response to different treatments.
- Mild eczema may be managed with liberal use of emollients and avoidance of irritants, while more severe cases may require topical corticosteroids or calcineurin inhibitors 5.
- Pimecrolimus, another topical calcineurin inhibitor, may also be used to treat eczema around the eyes, although its efficacy and safety profile may differ from that of tacrolimus 6, 7.
- In severe cases of eczema, ultraviolet phototherapy or systemic treatments may be necessary, although these options are typically reserved for cases that do not respond to topical treatments 5.