What is the treatment for dry scaly skin under the eyes?

Treatment of Dry, Scaly Skin Under the Eyes

Apply hydrocortisone 1% cream to the affected periocular skin 3-4 times daily for up to 2 weeks maximum, combined with hypoallergenic moisturizing cream at least once daily and preservative-free artificial tears at least 4 times daily. 1

Initial Treatment Protocol

The periocular skin requires a multi-pronged approach addressing both the skin barrier dysfunction and any associated ocular surface disease:

Topical Skin Management

• Apply hydrocortisone 1% cream to the dry, scaly areas under the eyes 3-4 times daily for a maximum of 2 weeks to reduce inflammation and restore the skin barrier 1
• Use hypoallergenic, preservative-free moisturizing cream to the periocular area at least once daily, with ceramide-containing formulations being particularly effective for restoring the skin's lipid barrier 1
• Limit corticosteroid use strictly to 2 weeks on eyelid skin to avoid complications including skin atrophy, telangiectasia, and systemic absorption 1

Ocular Surface Protection

• Apply preservative-free artificial tears containing methylcellulose or hyaluronate at least 4 times daily, increasing frequency based on symptom severity 1
• Use lubricating ointment at bedtime for overnight protection if any ocular surface symptoms are present 1

Lid Hygiene Protocol

This is essential even when the primary complaint is periocular skin changes, as blepharitis and meibomian gland dysfunction commonly contribute:

• Apply warm compresses to closed eyelids for 5-10 minutes twice daily using specially designed battery-powered or microwaveable eyelid warming devices 1
• Perform gentle eyelid massage after warm compresses to express thickened meibomian gland secretions 1
• Cleanse eyelid margins using diluted baby shampoo or commercial eyelid cleaners on a cotton pad to remove crusting and flaking 1

Environmental Modifications

These interventions address underlying triggers that perpetuate the condition:

• Eliminate exposure to cigarette smoke, which adversely affects the tear film lipid layer 1
• Humidify ambient air and avoid air drafts by using side shields on spectacles 1
• Lower computer screens below eye level to decrease eyelid aperture and reduce evaporative loss 1
• Schedule regular breaks during screen time and increase conscious blinking 1

Escalation for Refractory Cases

If symptoms persist after 2 weeks of initial therapy:

• Switch to tacrolimus 0.1% ointment applied once daily to external eyelids and lid margins for 2-4 weeks, which demonstrates 89% response rates for cases not responding to initial therapy 1
• Add topical antibiotic ointment to lid margins once or twice daily for 2-4 weeks if blepharitis is contributing 1
• Use lipid-containing tear supplements if meibomian gland dysfunction is contributing to symptoms 1

Critical Timing for Referral

• Arrange ophthalmology evaluation within 4 weeks if symptoms persist despite initial treatment 1
• Refer immediately if moderate or severe eye pain, vision loss or blurred vision, corneal infiltration or ulceration, or lack of response to initial therapy after 2-4 weeks develops 1

Common Pitfalls to Avoid

• Never extend topical corticosteroid use beyond 2 weeks on the eyelid skin due to the thin, sensitive nature of periocular tissue 1
• Avoid using preserved artificial tears more than 4 times daily, as overuse causes toxicity to the ocular surface 1
• Do not use tacrolimus ointment in patients with a history of ocular-surface herpes simplex virus or varicella zoster virus 1
• Counsel patients that long-term maintenance therapy may be required, as symptoms often recur when treatment is discontinued 1