Treatment of Contact Dermatitis Around the Eye
For contact dermatitis around the eye, topical tacrolimus 0.1% ointment applied once daily to the external eyelids and lid margins for 2-4 weeks is the recommended first-line treatment. 1
Initial Management
- Identify and avoid the causative allergen or irritant - This is crucial for successful treatment and preventing recurrence 1
- Apply preservative-free ocular lubricants - These help soothe the affected area and provide symptomatic relief 1
- Use lid hygiene measures - Specially designed eyelid warming devices or commercially available lid wipes can help clean the eyelid margins 1
Topical Treatment Options
First-line Treatment
- Tacrolimus 0.1% ointment - Apply once daily to external eyelids and lid margins for 2-4 weeks 1
For Children (2-17 years)
- Start with tacrolimus 0.03% ointment - Only following advice from ophthalmology 1
- Can increase to 0.1% if necessary - As an off-license treatment in appropriate cases 1
For Moderate-to-Severe Cases
- Short-term topical corticosteroids - Preferably preservative-free formulations 1
- Mid- to high-potency steroids - Such as triamcinolone 0.1% or clobetasol 0.05% for localized lesions 2
- Limit duration to maximum 8 weeks - Prolonged use increases risk of complications 1
- Caution with eyelid application - The thin skin of eyelids is prone to steroid-induced atrophy and telangiectasia 3
Additional Therapeutic Options
- Antihistamine eye drops - Can be added for mild-to-moderate cases with significant itching 1
- Warm compresses - May be beneficial in cases with meibomian gland dysfunction 1
- Patch testing - Consider for persistent cases to identify specific allergens 1, 4
- Ciclosporin eye drops - For moderate-to-severe cases that don't respond to initial therapy 1
When to Refer to Ophthalmology
- Children under 7 years - Due to limited ability to communicate symptoms and risk of interference with normal ocular development 1
- Moderate-to-severe cases - Especially if not responding to initial treatment 1
- Cases requiring topical corticosteroids - For monitoring and management of potential side effects 1
- Treatment-resistant disease - May require combination therapy or specialized treatments 1
Treatment Pitfalls and Caveats
- Avoid preservative-containing formulations - These can cause additional allergic contact dermatitis 1
- Be cautious with topical corticosteroids - Prolonged use on eyelids can lead to atrophy, telangiectasia, glaucoma, and cataracts 5, 3
- Consider underlying conditions - Contact dermatitis may be part of atopic dermatitis or other skin conditions 1
- Monitor for secondary infection - If present, appropriate antifungal or antibacterial therapy should be initiated 5
- Corticosteroids may be ineffective for certain types of irritant contact dermatitis - Particularly those induced by surfactants 6
Follow-up
- For cases treated with tacrolimus ointment - Arrange ophthalmology review within 4 weeks 1
- For cases using topical corticosteroids - Regular monitoring for signs of skin atrophy, glaucoma, and cataracts 1, 5
- Assess response to treatment - If no improvement, consider alternative diagnosis or referral to specialist 1