Can I use hydrocortisone (cortisol) under my eyes?

Can You Use Hydrocortisone Under the Eyes?

Yes, hydrocortisone 1% can be safely used under the eyes for periocular dermatitis, but only for short-term treatment (2-4 weeks maximum) and with specific precautions. 1

First-Line Treatment Approach

• Hydrocortisone 1% is the recommended first-line topical corticosteroid for periocular (under-eye) dermatitis because of its favorable safety profile for the thin periocular skin 1
• Apply twice daily for a maximum of 2-4 weeks 1
• Combine with liberal emollient application to restore the skin barrier, using soap-free cleansers and avoiding alcohol-containing products near the eyes 1

Critical Safety Precautions

Avoid direct eye contact - The FDA label explicitly warns to "avoid contact with eyes" when using topical hydrocortisone 2. This means applying it to the skin around the eyes (periocular area), not in the eyes themselves.

Specific Risks of Periocular Use

• Long-term application can cause atrophy and telangiectasia of the eyelids, even with 1% hydrocortisone 3
• Chronic uninterrupted use may trigger rosacea-like eruptions or perioral dermatitis 3
• Minimize periocular steroid use due to unclear associations with cataracts and glaucoma 4
• The complications are generally less severe than with more potent corticosteroids, but still warrant caution in vulnerable areas like eyelids 3

When to Stop and Switch

If symptoms persist beyond 2-4 weeks or the condition is chronic, switch to tacrolimus 0.1% ointment applied once daily, which has an 89% response rate for eyelid eczema 1. Tacrolimus offers advantages over continued corticosteroids:

• No risk of skin atrophy or telangiectasia 1
• No elevation of intraocular pressure 1
• However, it may increase susceptibility to herpes simplex keratitis, requiring monitoring for eczema herpeticum 1

Red Flags Requiring Ophthalmology Referral

Refer to ophthalmology if: 1

• Moderate-to-severe disease requiring corticosteroids beyond 8 weeks
• Treatment-resistant disease despite appropriate therapy
• Children under 7 years with periocular eczema
• Any suspected eye involvement (conjunctivitis, vision changes)

Alternative for Ocular Surface Involvement

If the problem extends to the ocular surface itself (not just periocular skin), preservative-free hydrocortisone 0.335% eyedrops are available and have demonstrated safety and efficacy for ocular inflammation 4, 5. A randomized trial showed this formulation reduced ocular inflammation and symptoms without changing intraocular pressure over 14 days of treatment 5.

Common Pitfalls to Avoid

• Never use continuously without breaks - therapy with any topical corticosteroid should be intermittent 3
• Do not exceed 2-4 weeks without reassessment - prolonged use increases risk of complications 1
• Do not use if there is suspected infection - corticosteroids can worsen herpes simplex infections 6
• Stop immediately if condition worsens or symptoms persist beyond 7 days without improvement 2