What treatment can be used for periorbital erythema caused by eye rubbing?

Treatment for Periorbital Erythema Due to Eye Rubbing

For periorbital erythema caused by eye rubbing, the most effective first-line treatment is cold compresses combined with avoidance of further eye rubbing, as this addresses both the inflammation and prevents worsening of the condition. 1, 2

First-Line Treatments

• Apply cold compresses to the affected area for several minutes to reduce inflammation and provide symptomatic relief 1, 2
• Use refrigerated artificial tears to dilute inflammatory mediators on the ocular surface and provide additional cooling relief 1
• Strictly avoid further eye rubbing, as this is crucial to prevent worsening of symptoms and potential complications like keratoconus 1
• Consider wearing sunglasses as a barrier if the eye rubbing is triggered by environmental irritants 1, 2

Second-Line Treatments

If symptoms persist despite first-line measures:

• Over-the-counter topical antihistamine/vasoconstrictor agents can be used if allergic components are suspected 1, 2
• Second-generation topical histamine H1-receptor antagonists are more effective for reducing inflammation and itching 1
• Preservative-free artificial tears (refrigerated) can help dilute allergens and inflammatory mediators while providing symptomatic relief 1, 2

For Persistent or Severe Cases

• A brief course (1-2 weeks) of low-potency topical corticosteroids may be considered for inadequately controlled symptoms 1
• If using corticosteroids, monitor for potential side effects including increased intraocular pressure and cataract formation 1
• For cases with significant allergic component, topical mast-cell stabilizers may be beneficial 1

Eyelid Hygiene Measures

• Gentle eyelid cleansing can be performed to remove any irritants that may be contributing to the urge to rub 1
• Hypochlorous acid-based eye cleaners (0.01%) have antimicrobial effects that may help reduce inflammation 1
• Avoid aggressive manipulation of the eyelids as this may lead to mechanically induced irritation 1

Important Considerations

• If the periorbital erythema is associated with allergic conjunctivitis, addressing the underlying allergy is essential 1
• Persistent eye rubbing can lead to more serious conditions such as keratoconus, making prevention of rubbing critical 1
• If symptoms worsen or do not improve within 1-2 weeks, consider referral to ophthalmology to rule out other conditions 1
• Oral antihistamines may be considered but can potentially worsen dry eye syndrome, which might increase the urge to rub 1, 2

Treatment Algorithm

1. Start with cold compresses and refrigerated artificial tears
2. Implement strict avoidance of eye rubbing
3. If no improvement in 2-3 days, add topical antihistamine/vasoconstrictor
4. For persistent symptoms after 1 week, consider a brief course of low-potency topical corticosteroid
5. Refer to ophthalmology if symptoms persist beyond 2 weeks or worsen at any point

This approach targets both the inflammatory response causing the erythema and addresses the underlying behavior (eye rubbing) that initiated the condition.