What are safe topical creams for a patient with dry, mildly flaking, red corners of the eyelid (canthus), without scleral involvement, conjunctivitis, eyelid swelling, or signs of infection?

From the Guidelines

For dry, mildly flaking red corners of the eyelids without other complications, I recommend starting with a gentle, fragrance-free moisturizing eye cream containing ceramides, hyaluronic acid, or squalane. Specific over-the-counter options include CeraVe Eye Repair Cream, Neutrogena Hydro Boost Eye Gel-Cream, or La Roche-Posay Toleriane Ultra Eye Cream 1. Apply a small amount (about the size of a grain of rice) to the affected area twice daily after gently cleansing with a mild cleanser. If symptoms persist beyond 1-2 weeks, a low-potency hydrocortisone cream (0.5-1%) can be used sparingly for up to 7 days to reduce inflammation, but avoid getting it in the eyes. For persistent symptoms, consider eyelid-specific products like Ocusoft Lid Scrub or Avenova eyelid cleanser to remove debris and reduce bacterial load 1. These symptoms often result from seborrheic dermatitis, eczema, or mild blepharitis, which respond well to consistent moisturizing and gentle cleansing. Avoid rubbing the eyes, using harsh makeup removers, and discontinue any product that causes irritation. If symptoms worsen or don't improve after two weeks of home treatment, consult a healthcare provider as prescription treatments may be necessary. It's also important to address any potentially exacerbating factors, such as environmental factors like air drafts and low-humidity environments, as suggested in the dry eye syndrome preferred practice pattern 1. Additionally, humidifying ambient air and avoiding air drafts by using side shields on spectacles and by changing the characteristics of airflow at work, at home, and in the car may be helpful 1. Topical antibiotics or other prescription treatments may be considered if symptoms persist or worsen, but these should be used under the guidance of a healthcare provider 1.

From the FDA Drug Label

Active Ingredient Hydrocortisone 1% PRINCIPAL DISPLAY PANEL - 28.4 g Tube Carton TopCare health ™ MAXIMUM STRENGTH • OUR PHARMACISTS RECOMMEND • NDC 36800-099-02 Hydrocortisone 1% Cream ANTIPRURITIC (ANTI-ITCH) Intensive Healing Formula † NET WT 1 OZ (28.4 g) Purpose Anti-itch

Safe topical eyelid creams for a patient with dry and mildly flaking red corner of eyelid, but no sclera involvement at all, no conjunctivitis, no eyelid swelling nor infection appearance, may include:

• Hydrocortisone 1% cream 2, 2, 2 This cream is labeled as an antipruritic (anti-itch) and can be used for intensive healing. However, it is essential to use it with caution and under medical supervision, as hydrocortisone can have side effects, especially with long-term use.

From the Research

Safe Topical Eyelid Creams

For a patient with dry and mildly flaking red corner of eyelid, but no sclera involvement, no conjunctivitis, no eyelid swelling, nor infection appearance, the following options can be considered:

• Non-steroidal ant-inflammatory agents, such as topical calcineurin inhibitors (TCIs), are a viable alternative to topical corticosteroids in treating dermatitis of the face, neck, eyelids, and intertriginous areas 3
• Medical device emollients, such as ceramide-hyaluronic acid emollient foam, can provide anti-oxidant, anti-protease, anti-inflammatory activity, and aid in restoring the natural balance of lipids 3
• Topical corticosteroids, such as hydrocortisone 1% cream, can be used to treat inflammatory skin conditions, but their use should be limited to the shortest duration necessary and with caution due to potential side effects 4
• Ceramide-containing formulations with 1% pramoxine hydroxide, such as CeraVe Itch Relief Lotion and Cream, can provide rapid and long-lasting relief of itching and are well tolerated with aesthetic appeal 5

Key Considerations

When selecting a topical eyelid cream, it is essential to consider the following factors:

• The patient's medical history and current condition
• The potential risks and benefits of each treatment option
• The need for careful assessment and accurate diagnosis to determine the underlying cause of the red eye
• The importance of correct patient application and adherence to treatment instructions 6, 7