What is the treatment for eczema around the eyes?

Treatment for Eczema Around the Eyes

For eczema around the eyes, low-potency topical corticosteroids should be used for short-term treatment (limited to 4 weeks), while topical calcineurin inhibitors (TCIs) are the preferred first-line treatment due to their better safety profile for this sensitive area. 1

First-Line Treatment Options

Topical Calcineurin Inhibitors (TCIs)

• Preferred first-line treatment for facial eczema, including around the eyes 1
• Advantages:
  • No risk of skin atrophy (thinning)
  • Safer for long-term use in sensitive areas
  • Can be used 2-3× weekly for maintenance therapy after initial control 1
• Examples: tacrolimus ointment, pimecrolimus cream

Low-Potency Topical Corticosteroids

• Appropriate for short-term treatment (≤4 weeks) 1
• Apply once daily (as effective as twice daily) 1
• Examples: hydrocortisone 1%, desonide 0.05%
• Caution: Prolonged use around eyes can increase risk of glaucoma, cataracts, and skin atrophy

Moisturization and Skin Care

• Apply fragrance-free emollients multiple times daily, especially after bathing 1, 2
• Ointments provide maximum occlusion for very dry skin, while creams offer a good balance of hydration and acceptability 1
• Moisturizers with specific ingredients show better efficacy:
  • Glycerol-containing moisturizers improve skin condition 1, 3
  • Urea-containing creams help with dryness 3
• Regular moisturization reduces flares and decreases need for topical corticosteroids 2, 3

Maintenance Therapy

• After disease stabilization:
  • TCIs can be used 2-3× weekly on previously affected skin 1
  • Low-potency corticosteroids can be used 1-2× weekly (intermittent application) 1
• Consistent moisturizer use is crucial for preventing flares 1, 2

Managing Flares and Complications

• If signs of infection appear (increased redness, crusting, oozing):
  • Consider antiseptic washes with aqueous chlorhexidine 0.05% 1
  • Oral antibiotics may be needed if clinically indicated 1
• For severe, refractory cases:
  • Referral to a dermatologist for consideration of systemic therapy 1
  • Short courses of oral corticosteroids (<7 days) may be considered for severe acute flares 1

Avoiding Triggers and Lifestyle Modifications

• Use gentle, pH-neutral synthetic detergents instead of soap 1
• Avoid irritants such as perfumes, deodorants, and alcohol-based lotions 1
• Keep nails short to minimize damage from scratching 1
• Consider air purifiers to reduce PM 2.5 exposure, especially during dry weather 1

Common Pitfalls to Avoid

1. Using medium or high-potency corticosteroids around eyes - can lead to skin atrophy and ocular complications
2. Prolonged continuous use of topical corticosteroids - should be limited to 4 weeks 1
3. Neglecting maintenance therapy - intermittent application prevents flares 1
4. Inadequate moisturization - emollients should be applied multiple times daily, even when skin appears normal 1, 2
5. Delayed follow-up - reassessment after 2 weeks of treatment is necessary to monitor for side effects and treatment response 1

When to Refer to a Specialist

• If diagnosis remains uncertain
• Poor response to first-line treatment after 2-3 weeks
• Recurrent or severe disease requiring systemic therapy
• Suspected contact dermatitis or other complications 1