What is the treatment for lower eyelid contact dermatitis?

Treatment of Lower Eyelid Contact Dermatitis

Tacrolimus 0.1% ointment is the first-line treatment for lower eyelid contact dermatitis, applied once daily to external eyelids and lid margins for 2-4 weeks, with an 89% response rate. 1

First-Line Treatment Options

• Identify and avoid the causative allergen or irritant for successful treatment and prevention of recurrence 1
• Apply preservative-free ocular lubricants (such as hyaluronate drops) 2-4 times daily to provide symptomatic relief 1, 2
• Use tacrolimus 0.1% ointment once daily to external eyelids and lid margins for 2-4 weeks 2, 1
• For children aged 2-17 years, start with tacrolimus 0.03% ointment (only following ophthalmology advice), with potential to increase to 0.1% if necessary 2, 1

Second-Line Treatment Options

• Add antihistamine eye drops (such as olopatadine) twice daily if first-line treatment is ineffective or for moderate cases with significant itching 2, 1
• Implement lid hygiene measures using specially designed eyelid warming devices or commercially available lid wipes to clean the eyelid margins 2, 1
• Apply warm compresses for cases with associated meibomian gland dysfunction 2, 1

Treatment for Moderate-to-Severe Cases

• Refer to ophthalmology for moderate-to-severe cases not responding to initial treatment 2, 1
• Short-term topical corticosteroids may be prescribed by ophthalmologists for moderate-to-severe cases, but should be limited to a maximum of 8 weeks to avoid complications 2, 3
• Consider ciclosporin eye drops for moderate-to-severe cases that don't respond to initial therapy (typically initiated by ophthalmologists) 2

Special Considerations

For Children

• Children under 7 years should be referred to ophthalmology due to limited ability to communicate symptoms and risk of interference with normal ocular development 2, 1
• Tacrolimus 0.03% ointment can be considered for children aged 2-17 years, but only following advice from ophthalmology 2, 1

For Contact Lens Wearers

• Immediately remove contact lenses and discontinue wear until the cornea completely returns to normal 4
• Review the contact lens fit, type, and care regimen, and consider recommending non-preserved lens care systems or daily disposable contact lenses 4

Treatment for Refractory Cases

• Consider patch testing for persistent cases to identify specific allergens 1, 5
• For treatment-resistant cases, combination therapy with topical corticosteroids, tacrolimus ointment, and ciclosporin drops may be considered 1, 6

Treatment Pitfalls and Caveats

• Avoid preservative-containing formulations as they can cause additional allergic contact dermatitis 1, 6
• Use topical corticosteroids with extreme caution around the eyes, as they may cause skin atrophy, glaucoma, and cataracts with prolonged use 2, 3
• Hydrocortisone should be applied no more than 3-4 times daily and only for short periods 3
• Rebound dermatitis can occur with rapid discontinuation of topical steroids 7

Follow-up Recommendations

• Cases treated with tacrolimus ointment should be arranged for ophthalmology review within 4 weeks 2, 1
• Cases using topical corticosteroids require regular monitoring for signs of skin atrophy, glaucoma, and cataracts 2, 1
• If no improvement is seen after 4 weeks of treatment, consider alternative diagnosis or referral to specialist 1, 6