From the Guidelines
Periorbital dermatitis is typically triggered by contact allergic allergens, and treatment involves identification and avoidance of these allergens, as well as lid hygiene measures, including warm compresses and eyelid massage, as recommended in the most recent expert consensus 1. To manage periorbital dermatitis, it is essential to identify and avoid potential triggers, such as contact allergens, which have been shown to improve ocular surface disease in some patients 1.
Key Trigger Factors
- Contact allergic allergens
- Topical steroid use
- Cosmetics
- Skin care products
- Underlying conditions like rosacea or seborrheic dermatitis
Treatment Approach
- Discontinuing any potential irritants, particularly topical steroids
- Lid hygiene measures, including:
- Warm compresses using specially designed, battery-powered devices or microwaveable eyelid warming devices
- Eyelid massage to soften the oils
- Cleaning eyelid margins to unblock the oil glands and remove excess bacteria
- Using homemade bicarbonate solution or commercially available lid wipes
- For patients with dupilumab-related ocular surface disorders, dose reduction may be a useful approach, with increased dose intervals to 300 mg 3-weekly leading to an improvement in symptoms in 47% of cases 1.
Medical Treatment
- Topical antibiotics or topical calcineurin inhibitors may be considered, but the most recent expert consensus does not provide specific recommendations for these treatments 1. It is crucial to note that the treatment approach should be individualized, and patients should be closely monitored for any worsening of symptoms, particularly during the first 3 months of treatment 1.
From the Research
Triggers of Periorbital Dermatitis
- Allergic contact dermatitis is a common cause of periorbital dermatitis, with leave-on cosmetic products and eye drops being frequent elicitors 2
- Atopic eczema is also a significant trigger, with female gender, atopic skin diathesis, and age of 40 years and older being identified as risk factors 2
- Irritant contact dermatitis and airborne contact dermatitis can also contribute to the development of periorbital dermatitis 2
- Other less frequent causes include periorbital rosacea, allergic conjunctivitis, and psoriasis vulgaris 2
- Paederus dermatitis, a type of contact dermatitis caused by an insect, can also mimic preseptal cellulitis and should be considered in the differential diagnosis 3
Treatment of Periorbital Dermatitis
- Exact identification of relevant contact allergens and allergen elimination are essential for successful treatment 2
- Calcineurin inhibitors, such as topical pimecrolimus, may be effective in treating periocular eczematous lesions, although they are not approved for this use 2
- Topical metronidazole gel (0.75%) has been shown to be effective in treating perioral or periocular eruptions in children 4
- Wet dressings, weak steroid ointments, and antibiotic ointments may be used to treat Paederus dermatitis 3
- Elimination of topical corticosteroids and gradual reduction of skin-care products can lead to clearing of the condition 5