From the Guidelines
For swelling and eczema around the eye, I recommend starting with a gentle, fragrance-free cleanser and applying a mild, hypoallergenic moisturizer like Vanicream or CeraVe. For mild cases, use a low-potency topical corticosteroid such as hydrocortisone 1% cream twice daily for 5-7 days, being careful to avoid getting it in the eye, as suggested by 1. For moderate to severe cases, a prescription-strength corticosteroid like triamcinolone 0.1% or tacrolimus 0.03% ointment may be needed. Cold compresses applied for 10-15 minutes several times daily can help reduce swelling. Oral antihistamines like cetirizine 10mg or loratadine 10mg once daily may help if allergies are contributing to the condition, as seen in 1. Identify and avoid potential triggers such as makeup, skincare products, or environmental allergens. If symptoms don't improve within a week, or if you experience severe pain, vision changes, or spreading redness, seek medical attention immediately. These treatments work by reducing inflammation, which is the body's response to irritation or allergens that causes the redness, swelling, and itching characteristic of eczema around the eyes. Some key considerations include:
- Using warm compresses to soften adherent scurf and scales or discharge and/or warm the meibomian secretions, as mentioned in 1
- Eyelid cleansing, including eyelid massage in cases of meibomian gland dysfunction to express the meibomian glands, as discussed in 1
- Avoiding potential triggers and maintaining good eyelid hygiene, as emphasized in 1 and 1
- Considering the potential for ocular surface disorders, such as dry eyes, blepharitis, or meibomian gland dysfunction, as highlighted in 1
From the FDA Drug Label
Do not use ELIDEL Cream in the eyes. If ELIDEL Cream gets in the eyes, rinse them with cold water. The FDA drug label does not provide a treatment for swelling and eczema around the eye using pimecrolimus cream, and actually advises against using it in the eyes.
From the Research
Treatment Options for Swelling and Eczema Around the Eye
- Topical corticosteroids are the usual treatment for atopic dermatitis, but long-term use can lead to local side effects such as skin atrophy and systemic side effects 2.
- Topical immunomodulators, such as tacrolimus and pimecrolimus, can be used as an alternative to topical corticosteroids, with a lower risk of skin atrophy 2, 3, 4.
- Tacrolimus and pimecrolimus have been shown to be effective in treating atopic dermatitis, with tacrolimus being comparable to a class 2 dermatocorticosteroid and pimecrolimus being comparable to a class 1 dermatocorticosteroid 2.
- A network meta-analysis found that potent topical corticosteroids, tacrolimus 0.1%, and ruxolitinib 1.5% were among the most effective treatments for eczema, while mild topical corticosteroids, roflumilast 0.15%, and crisaborole 2% were among the least effective 5.
Safety and Efficacy of Treatment Options
- Tacrolimus and pimecrolimus can cause local irritation, but this usually disappears after 2 weeks 2.
- Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, can increase the risk of local adverse effects, such as application-site reactions 5.
- Long-term safety studies have not revealed any new adverse events with the use of topical noncorticosteroid immunomodulators, but some adverse effects, such as an increased risk of photocarcinogenesis, need to be monitored 6.
Considerations for Treatment
- The American Academy of Dermatology recommends the use of topical corticosteroids as the first-line treatment for atopic dermatitis flare-ups, with topical calcineurin inhibitors, such as pimecrolimus and tacrolimus, being used in conjunction with topical corticosteroids as first-line treatment 3.
- Ultraviolet phototherapy is a safe and effective treatment for moderate to severe atopic dermatitis when first-line treatments are not adequate 3.
- Antistaphylococcal antibiotics are effective in treating secondary skin infections, but oral antihistamines are not recommended as they do not reduce pruritus 3.