II. Causes: Topicals used on or around the eye

  1. Eye cosmetics
    1. Eyeliner, Eyeshadow, or Mascara (shellac)
    2. Eye makeup remover (cocamidopropyl betaine which is also in hard Contact Lens solution)
    3. Nail polish (exposed when finger nails touch lids)
    4. Nickel eyelash curler
  2. Eye medications
    1. Ophthalmic Antibiotics
    2. Eye solutions (resorcinol, Amlexanox, Brimonidine, Levobunolol, NSAIDs, Beta Blockers)

III. Causes: Other

  1. See Allergic Contact Dermatitis
  2. See Irritant Contact Dermatitis
  3. Facial Tissue (with perfumes or dyes)
  4. Topical irritants or allergens spread to Eyelid via hands
    1. Nail polish and nail enhancers (methacrylates)
    2. Hair dye
    3. Face cream or Foundation
    4. Skin Lubricants
    5. Soaps
  5. Airborne irritants or allergens
    1. Dust or pollen
    2. Cleaning solutions or sprays
    3. Rosins
    4. Occupational exposures (isothiazolinones, epoxy acrylate, meropenem)

IV. Symptoms

  1. Pruritus suggests Allergic Contact Dermatitis
  2. Burning or stinging suggests Irritant Contact Dermatitis

V. Signs

  1. Initial: Marked local edema with variable erythema and vessicles
  2. Later: Scaling

VI. Differential Diagnosis

VII. Management

  1. Eliminate exposure to contact irritant or allergen
  2. Topical cold compresses
  3. Petroleum-based skin Emollient (e.g. vaseline)
  4. Topical Corticosteroids (low potency)
    1. Indicated for moderate to severe Allergic Contact Dermatitis
    2. Precautions
      1. Apply only to lid and avoid getting topical into eye
      2. Do not use longer than 10-14 days
        1. Risk of Eyelid skin atrophy
        2. Risk of Glaucoma, Cataracts, or periocular infection
    3. Preparations: Use twice daily for 5 to 10 days
      1. Desonide 0.05% cream
      2. Alclometasone dipropionate 0.05% cream

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