What treatment is recommended for dermatitis of the eye?

Treatment for Dermatitis of the Eye

For dermatitis of the eye, tacrolimus 0.1% ointment applied once daily to the external eyelids and lid margins for 2-4 weeks is the most effective treatment option, with 89% of cases showing good or very good response. 1

First-Line Treatment Options

For Mild to Moderate Cases:

• Ocular lubricants:
  • Preservative-free hyaluronate drops 2-4 times daily 1
  • Well-tolerated and cost-effective for dry eye conditions
  • 65% of cases achieve good or very good response 1

For Moderate Cases or If Lubricants Are Ineffective:

• Antihistamine eyedrops:
  • Olopatadine eyedrops twice daily in addition to ocular lubricants 1
  • Assess response after 1 month
  • Note: Only 42% of cases show good response to antihistamines 1

For More Severe Cases:

• Tacrolimus 0.1% ointment:

  • Apply once daily to external eyelids and lid margins for 2-4 weeks 1, 2
  • Most effective treatment with 89% response rate 1
  • Particularly beneficial for patients who have previously tolerated tacrolimus
  • Can be applied directly to the ocular surface of the lids for best effect (typically initiated by ophthalmology) 1

• Topical corticosteroid eyedrops:

  • 74% of cases show good or very good response 1
  • Should be limited to short-term use (< 8 weeks) to avoid complications 2
  • Caution: Long-term use can cause atrophy and telangiectasia of the eyelids 3

Additional Supportive Measures:

• Lid hygiene measures: 50% of cases achieve good response 1
• Warm compresses: Once or twice daily 2
• Gentle lid cleansing: Once or twice daily 2

Special Considerations

For Children:

• Children under 7 years: Early discussion (< 7 days) with ophthalmology before starting treatment 1
• Children 7-17 years: Tacrolimus ointment can be considered following advice from ophthalmology 1
• Antihistamine eyedrops are unlikely to be beneficial for children < 7 years 1

For Specific Conditions:

• Dupilumab-related ocular surface disorders (DROSD):

  • Pre-emptive treatment with ocular lubricants for those with pre-existing eye disease 1
  • Follow treatment algorithm starting with lubricants, then antihistamines, then tacrolimus 1

• Blepharitis:

  • May be associated with rosacea, metabolic syndrome, or medications like dupilumab 1
  • Treatment follows similar approach with emphasis on lid hygiene

When to Refer to Ophthalmology

Urgent Referral (within 1 week):

• Severe eyelid involvement
• Visual changes or corneal involvement
• Children under 7 years of age 2

Standard Referral:

• Moderate cases not responding to initial therapy
• Cases requiring topical corticosteroids for > 6 weeks 1, 2
• Adults with severe disease or non-response to topical treatment and lid hygiene 2

Treatment Pitfalls to Avoid

• Avoid long-term continuous use of topical corticosteroids on eyelids due to risk of atrophy and telangiectasia 3
• Do not delay referral to assess response to tacrolimus in severe cases 1
• Avoid tacrolimus in patients with history of ocular-surface herpes simplex virus or varicella zoster virus 1
• For patients requiring topical corticosteroids for > 6 weeks, consider corticosteroid-sparing therapy to avoid adverse effects 1

By following this treatment approach, most patients with dermatitis of the eye can achieve significant improvement in symptoms and prevent complications that could affect vision and quality of life.