What is the treatment for plastic glass lens dermatitis?

Treatment of Plastic Glass Lens (Eyeglass Frame) Dermatitis

Immediately discontinue wearing the offending eyeglasses and initiate tacrolimus 0.1% ointment applied once daily to the affected eyelid and periocular skin for 2-4 weeks as first-line treatment. 1

Immediate Management Steps

Allergen Identification and Avoidance

• Identify and eliminate the causative allergen from the eyeglass frames, which is essential for successful treatment and preventing recurrence. 1 Common culprits include:

  • Plasticizers and UV stabilizers (currently the most common allergens) 2
  • Nickel in frame varnish or metal components (even frames appearing silver or gold may contain nickel) 3
  • Dyes such as Solvent Orange 60, Solvent Yellow 14, and Solvent Red 179 4
  • Palladium in titanium frames 3
  • Plastic components (zyl, propionate, nylon, carbon, polycarbonate) 3

• Switch to hypoallergenic eyeglass frames made from materials less likely to cause reactions, as changing frame material is often the only definitive solution. 3

Supportive Care

• Apply preservative-free ocular lubricants immediately to soothe the affected periocular area and provide symptomatic relief as first-line supportive care. 1
• Avoid all preservative-containing formulations as they can cause additional allergic contact dermatitis. 1

Primary Topical Treatment

Tacrolimus Ointment (First-Line)

• Start tacrolimus 0.1% ointment applied once daily to external eyelids and lid margins for 2-4 weeks, which has demonstrated an 89% response rate in treating eyelid dermatitis. 1
• For children aged 2-17 years, start with tacrolimus 0.03% ointment and increase to 0.1% only if necessary and only following ophthalmology advice (off-license use). 1
• Arrange ophthalmology review within 4 weeks for all patients using tacrolimus ointment on lid margins. 1
• Discontinue tacrolimus and consider alternative treatments if no response after 2-4 weeks of appropriate use. 1

Short-Term Corticosteroid Option

• For mild cases with significant inflammation, a brief (1-2 weeks) course of topical corticosteroids may be used, though this provides only transient clinical resolution and does not prevent recurrences. 3, 5
• Hydrocortisone cream can be applied to affected areas not more than 3-4 times daily for adults and children 2 years and older. 6

Adjunctive Symptomatic Treatments

• Add topical antihistamine eye drops (olopatadine, ketotifen, or azelastine hydrochloride) for mild-to-moderate cases with significant itching. 1
• Apply warm compresses if meibomian gland dysfunction is present. 1
• Use lid hygiene measures such as specially designed eyelid warming devices or commercially available lid wipes to clean the eyelid margins. 7

Diagnostic Confirmation

• Consider patch testing for persistent cases unresponsive to initial treatment to identify specific allergens, including testing with Solvent Orange 60, Solvent Yellow 14, and scrapings from the patient's own spectacles. 1, 4
• Patch testing with analysis of softened scrapings from frames is a valuable diagnostic method for confirming the specific allergen. 3

Escalation for Treatment-Resistant Cases

• Refer to ophthalmology for moderate-to-severe cases not responding to initial therapy, where specialists may initiate short-term ocular topical corticosteroids or topical ciclosporin drops. 1
• Use combination therapy with tacrolimus ointment and ciclosporin drops for treatment-resistant cases. 1

Critical Referral Indications

• Immediately refer all children under 7 years to ophthalmology due to limited ability to communicate symptoms and risk of interference with normal ocular development. 1
• Refer any case requiring topical corticosteroids for monitoring of glaucoma and cataracts. 1
• Refer cases needing corticosteroid therapy for more than 8 weeks to ophthalmology. 1

Follow-Up Protocol

• Reassess at 4 weeks for patients on tacrolimus ointment during ophthalmology review, and consider alternative diagnosis or specialist referral if no improvement. 1
• Monitor regularly if topical corticosteroids are used, checking for signs of skin atrophy, glaucoma, and cataracts. 1

Common Pitfalls to Avoid

• Do not continue wearing the offending eyeglasses during treatment, as this will perpetuate the allergic reaction and prevent resolution. 3
• Do not rely solely on topical corticosteroids for long-term management, as they provide only temporary relief without addressing the underlying allergen exposure. 3
• Do not assume metal-free frames are hypoallergenic, as plastic frames contain multiple materials (plasticizers, UV stabilizers, dyes) that can cause reactions. 3, 2
• Do not overlook the possibility that "titanium" frames may contain palladium, which can cause allergic contact dermatitis. 3