What is the treatment for eczema (atopic dermatitis) of the eyelid?

From the Guidelines

The treatment for eczema of the eyelid should start with preservative-free lubricants applied twice daily to four times daily, and for moderate cases, olopatadine should be added twice daily. This approach is based on the most recent expert consensus on managing ocular surface disorders in people with atopic dermatitis 1. The treatment ladder for dermatology suggests that for mild cases, preservative-free lubricants are sufficient, while for moderate cases, the addition of olopatadine is recommended, and for severe cases, tacrolimus ointment to the lid margins once daily can be considered, especially in adults, with caution and consultation with an ophthalmologist for children between 7-17 years old.

Key considerations in the treatment of eyelid eczema include:

• Reducing inflammation and managing symptoms
• Avoiding triggers such as certain cosmetics, fragrances, or allergens
• Daily moisturizing with fragrance-free emollients to maintain the skin barrier
• Cold compresses to relieve itching and inflammation
• Oral antihistamines like cetirizine 10mg daily for significant itching
• Antibiotic treatment for suspected bacterial infections

It's also important to note that the treatment should be tailored to the severity of the condition and the patient's response to initial treatments. The use of tacrolimus or pimecrolimus can be beneficial for long-term management due to their non-steroidal nature, which reduces the risk of skin thinning associated with prolonged use of topical corticosteroids 1. However, the most recent and highest quality study 1 provides a clear, step-wise approach to managing eyelid eczema, emphasizing the use of preservative-free lubricants and olopatadine for moderate cases, which should be the primary guide for treatment decisions.

From the Research

Treatment Options for Eczema of the Eyelid

• The treatment for eczema (atopic dermatitis) of the eyelid includes topical immunomodulators such as tacrolimus and pimecrolimus, which are considered safe and effective alternatives to topical corticosteroids 2, 3, 4.
• Tacrolimus ointment 0.1% has been shown to be effective in reducing signs and symptoms of eyelid dermatitis, with 80% of patients experiencing marked improvement or better in a study of 21 patients with moderate to severe eyelid dermatitis 2.
• The use of tacrolimus ointment 0.1% has also been compared to corticosteroid ointment in a study of 25 patients with atopic keratoconjunctivitis, with results showing that both treatments were effective in reducing signs and symptoms of eyelid eczema, but tacrolimus had a near superior benefit in terms of eczema signs 4.

Safety and Efficacy

• The safety and efficacy of tacrolimus ointment 0.1% have been assessed in several studies, with results showing that it is well-tolerated and effective in reducing signs and symptoms of eyelid dermatitis 2, 3, 4.
• Common adverse events associated with the use of tacrolimus ointment 0.1% include local burning and itching, but these are typically mild and transient 2, 3.
• There is no evidence to suggest that topical tacrolimus increases the risk of malignancies or skin atrophy, and it may be a safer alternative to topical corticosteroids for long-term use 3.

Comparison to Other Treatments

• Tacrolimus ointment 0.1% has been compared to other treatments, including pimecrolimus 1% and corticosteroid ointments, with results showing that it is more effective in reducing signs and symptoms of eyelid dermatitis 3, 4.
• The use of tacrolimus ointment 0.1% may be preferred over corticosteroid ointments due to its safety profile and lack of systemic side effects, particularly in patients with atopic keratoconjunctivitis 4.