The eyelids are one of the most sensitive regions of the body, making them very susceptible to contact dermatitis. This may be explained by two major theories. The skin of the eyelids is quite thin (0.55 mm) compared to other sites on the face (2.0 mm); this suggests the eyelids would be more susceptible to damage and irritation.1,2 The other theory focuses on the sphincter function of the orbicularis oculi. The accordion-like movement of the upper eyelid during blinking may lead to potential allergens becoming trapped and retained between the folded skin when the eye is open.3 This would result in prolonged exposure. Regardless, the eyelids are more susceptible to both irritant and allergic contact dermatitis.
Presentation
Similar to the face, the eyelid region can be more easily approached by considering categories of allergen exposure. The five major categories are scalp-applied allergens, aeroallergens, directly contacted allergens, ectopic allergens and inadvertent allergens. The first two categories have been previously covered in the scalp and face series. We will consider the latter three further.
Directly applied allergens include anything directly applied or exposed to the eyelid. This list is nearly endless and includes a myriad of cosmetics, cleansers and ophthalmic medicaments. The most common allergens in this category are fragrances, preservatives and nickel.4,5 Nickel can be found as an ingredient or contaminate in personal care products such as make-up, but it is also found frequently in applicators.6 These applicators may also be a source of rubber or black dye (paraphenylenediamine) exposure.
A predominance of the lower eyelids with a “run-off or drip” pattern should raise suspicion of ophthalmic solutions.3 See Figure 1. Ophthalmic medications may contain potentially irritating and sensitizing preservatives such as benzolkonium chloride, thimerosal merthiolate, chlorobutanol, chlorohexidine or phenylmercuric.2 Topical medicaments such as antibiotics and steroids should also be considered.
Finally, this category also includes things like swim goggles, binocular or telescope eye pieces, eye patches, etc. See Figure 2. These objects often cause a characteristic dermatitis that mimics their use. Figure 3 shows unilateral eyelid dermatitis in a medical technician student who used a monocular microscope with a rubber eyepiece.
Figures 1-3 (left to right)
Figure 1: Lower eyelid dermatitis due to ophthalmic medicaments.
Figure 2: Annular dermatitis due to goggles, binocolars or other eye pieces.
Figure 3: Unilateral eyelid dermatitis as seen on a medical technician student using a monocular microscope with a rubber eye piece.
The category of “ectopic allergens” is an interesting one. The term is most often used when talking about eyelid dermatitis in relationship to gold.7 It refers to the allergen source being removed or at an ectopic site from the dermatitis. Typically this is a gold ring on the finger. The situation is somewhat perplexing in that patients frequently do not have a reaction on the finger. The explanation for this seems to be that gold is released from the allergen source in the presence of sweat and abrasive particles like titanium dioxide, a frequent ingredient in cosmetics.7 Data from the North American Contact Dermatitis Group (NACDG) published in Dermatitis looked at isolated eyelid contact dermatitis and found that gold was the most frequently encountered allergen producing a positive patch test.4
The “inadvertent allergens” are an easily forgotten but important cause of eyelid dermatitis. The eyelids are frequently rubbed and touched which leads to transfer of substances from the hands. In this manner, they eyelids may be exposed to a multitude of potential allergens. This type of allergen spread often appears as an isolated, asymmetric upper eyelid dermatitis. Some common sources include hand sanitizer, hand soap, hand moisturizer and nail polish.2,3 The thicker skin of the hands is often spared.
Recommendations
When allergic contact dermatitis of the eyelid is suspected, empiric use of minimally or hypoallergic scalp-applied products, cleansers, cosmetics and topical medications and products may be helpful.
Ms. Huynh is with the Center for Dermatology Research and the department of dermatology at Wake Forest University School of Medicine in Winston-Salem, NC.
Drs. Sheehan and Zirwas and Mr. Chung are with the Center for Dermatology Research at Wake Forest University School of Medicine.
Dr. Feldman is with the Center for Dermatology Research and the departments of dermatology, pathology and public health sciences at Wake Forest School of Medicine.
Disclosure: The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P. Dr. Feldman has received research, speaking and/or consulting support from Galderma, Abbott Labs, Warner Chilcott, Aventis Pharmaceuticals, 3M, Connetics, Roche, Amgen, Biogen, Stiefel, GlaxoSmithKline and Genentech. Dr. Zirwas receives consulting support from Coria Labs, Taro Pharma and SmartPractice. Dr. Sheehan, Ms. Huynh and Mr. Chung have no conflicts to disclose.
The eyelids are one of the most sensitive regions of the body, making them very susceptible to contact dermatitis. This may be explained by two major theories. The skin of the eyelids is quite thin (0.55 mm) compared to other sites on the face (2.0 mm); this suggests the eyelids would be more susceptible to damage and irritation.1,2 The other theory focuses on the sphincter function of the orbicularis oculi. The accordion-like movement of the upper eyelid during blinking may lead to potential allergens becoming trapped and retained between the folded skin when the eye is open.3 This would result in prolonged exposure. Regardless, the eyelids are more susceptible to both irritant and allergic contact dermatitis.
Presentation
Similar to the face, the eyelid region can be more easily approached by considering categories of allergen exposure. The five major categories are scalp-applied allergens, aeroallergens, directly contacted allergens, ectopic allergens and inadvertent allergens. The first two categories have been previously covered in the scalp and face series. We will consider the latter three further.
Directly applied allergens include anything directly applied or exposed to the eyelid. This list is nearly endless and includes a myriad of cosmetics, cleansers and ophthalmic medicaments. The most common allergens in this category are fragrances, preservatives and nickel.4,5 Nickel can be found as an ingredient or contaminate in personal care products such as make-up, but it is also found frequently in applicators.6 These applicators may also be a source of rubber or black dye (paraphenylenediamine) exposure.
A predominance of the lower eyelids with a “run-off or drip” pattern should raise suspicion of ophthalmic solutions.3 See Figure 1. Ophthalmic medications may contain potentially irritating and sensitizing preservatives such as benzolkonium chloride, thimerosal merthiolate, chlorobutanol, chlorohexidine or phenylmercuric.2 Topical medicaments such as antibiotics and steroids should also be considered.
Finally, this category also includes things like swim goggles, binocular or telescope eye pieces, eye patches, etc. See Figure 2. These objects often cause a characteristic dermatitis that mimics their use. Figure 3 shows unilateral eyelid dermatitis in a medical technician student who used a monocular microscope with a rubber eyepiece.
Figures 1-3 (left to right)
Figure 1: Lower eyelid dermatitis due to ophthalmic medicaments.
Figure 2: Annular dermatitis due to goggles, binocolars or other eye pieces.
Figure 3: Unilateral eyelid dermatitis as seen on a medical technician student using a monocular microscope with a rubber eye piece.
The category of “ectopic allergens” is an interesting one. The term is most often used when talking about eyelid dermatitis in relationship to gold.7 It refers to the allergen source being removed or at an ectopic site from the dermatitis. Typically this is a gold ring on the finger. The situation is somewhat perplexing in that patients frequently do not have a reaction on the finger. The explanation for this seems to be that gold is released from the allergen source in the presence of sweat and abrasive particles like titanium dioxide, a frequent ingredient in cosmetics.7 Data from the North American Contact Dermatitis Group (NACDG) published in Dermatitis looked at isolated eyelid contact dermatitis and found that gold was the most frequently encountered allergen producing a positive patch test.4
The “inadvertent allergens” are an easily forgotten but important cause of eyelid dermatitis. The eyelids are frequently rubbed and touched which leads to transfer of substances from the hands. In this manner, they eyelids may be exposed to a multitude of potential allergens. This type of allergen spread often appears as an isolated, asymmetric upper eyelid dermatitis. Some common sources include hand sanitizer, hand soap, hand moisturizer and nail polish.2,3 The thicker skin of the hands is often spared.
Recommendations
When allergic contact dermatitis of the eyelid is suspected, empiric use of minimally or hypoallergic scalp-applied products, cleansers, cosmetics and topical medications and products may be helpful.
Ms. Huynh is with the Center for Dermatology Research and the department of dermatology at Wake Forest University School of Medicine in Winston-Salem, NC.
Drs. Sheehan and Zirwas and Mr. Chung are with the Center for Dermatology Research at Wake Forest University School of Medicine.
Dr. Feldman is with the Center for Dermatology Research and the departments of dermatology, pathology and public health sciences at Wake Forest School of Medicine.
Disclosure: The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P. Dr. Feldman has received research, speaking and/or consulting support from Galderma, Abbott Labs, Warner Chilcott, Aventis Pharmaceuticals, 3M, Connetics, Roche, Amgen, Biogen, Stiefel, GlaxoSmithKline and Genentech. Dr. Zirwas receives consulting support from Coria Labs, Taro Pharma and SmartPractice. Dr. Sheehan, Ms. Huynh and Mr. Chung have no conflicts to disclose.
The eyelids are one of the most sensitive regions of the body, making them very susceptible to contact dermatitis. This may be explained by two major theories. The skin of the eyelids is quite thin (0.55 mm) compared to other sites on the face (2.0 mm); this suggests the eyelids would be more susceptible to damage and irritation.1,2 The other theory focuses on the sphincter function of the orbicularis oculi. The accordion-like movement of the upper eyelid during blinking may lead to potential allergens becoming trapped and retained between the folded skin when the eye is open.3 This would result in prolonged exposure. Regardless, the eyelids are more susceptible to both irritant and allergic contact dermatitis.
Presentation
Similar to the face, the eyelid region can be more easily approached by considering categories of allergen exposure. The five major categories are scalp-applied allergens, aeroallergens, directly contacted allergens, ectopic allergens and inadvertent allergens. The first two categories have been previously covered in the scalp and face series. We will consider the latter three further.
Directly applied allergens include anything directly applied or exposed to the eyelid. This list is nearly endless and includes a myriad of cosmetics, cleansers and ophthalmic medicaments. The most common allergens in this category are fragrances, preservatives and nickel.4,5 Nickel can be found as an ingredient or contaminate in personal care products such as make-up, but it is also found frequently in applicators.6 These applicators may also be a source of rubber or black dye (paraphenylenediamine) exposure.
A predominance of the lower eyelids with a “run-off or drip” pattern should raise suspicion of ophthalmic solutions.3 See Figure 1. Ophthalmic medications may contain potentially irritating and sensitizing preservatives such as benzolkonium chloride, thimerosal merthiolate, chlorobutanol, chlorohexidine or phenylmercuric.2 Topical medicaments such as antibiotics and steroids should also be considered.
Finally, this category also includes things like swim goggles, binocular or telescope eye pieces, eye patches, etc. See Figure 2. These objects often cause a characteristic dermatitis that mimics their use. Figure 3 shows unilateral eyelid dermatitis in a medical technician student who used a monocular microscope with a rubber eyepiece.
Figures 1-3 (left to right)
Figure 1: Lower eyelid dermatitis due to ophthalmic medicaments.
Figure 2: Annular dermatitis due to goggles, binocolars or other eye pieces.
Figure 3: Unilateral eyelid dermatitis as seen on a medical technician student using a monocular microscope with a rubber eye piece.
The category of “ectopic allergens” is an interesting one. The term is most often used when talking about eyelid dermatitis in relationship to gold.7 It refers to the allergen source being removed or at an ectopic site from the dermatitis. Typically this is a gold ring on the finger. The situation is somewhat perplexing in that patients frequently do not have a reaction on the finger. The explanation for this seems to be that gold is released from the allergen source in the presence of sweat and abrasive particles like titanium dioxide, a frequent ingredient in cosmetics.7 Data from the North American Contact Dermatitis Group (NACDG) published in Dermatitis looked at isolated eyelid contact dermatitis and found that gold was the most frequently encountered allergen producing a positive patch test.4
The “inadvertent allergens” are an easily forgotten but important cause of eyelid dermatitis. The eyelids are frequently rubbed and touched which leads to transfer of substances from the hands. In this manner, they eyelids may be exposed to a multitude of potential allergens. This type of allergen spread often appears as an isolated, asymmetric upper eyelid dermatitis. Some common sources include hand sanitizer, hand soap, hand moisturizer and nail polish.2,3 The thicker skin of the hands is often spared.
Recommendations
When allergic contact dermatitis of the eyelid is suspected, empiric use of minimally or hypoallergic scalp-applied products, cleansers, cosmetics and topical medications and products may be helpful.
Ms. Huynh is with the Center for Dermatology Research and the department of dermatology at Wake Forest University School of Medicine in Winston-Salem, NC.
Drs. Sheehan and Zirwas and Mr. Chung are with the Center for Dermatology Research at Wake Forest University School of Medicine.
Dr. Feldman is with the Center for Dermatology Research and the departments of dermatology, pathology and public health sciences at Wake Forest School of Medicine.
Disclosure: The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P. Dr. Feldman has received research, speaking and/or consulting support from Galderma, Abbott Labs, Warner Chilcott, Aventis Pharmaceuticals, 3M, Connetics, Roche, Amgen, Biogen, Stiefel, GlaxoSmithKline and Genentech. Dr. Zirwas receives consulting support from Coria Labs, Taro Pharma and SmartPractice. Dr. Sheehan, Ms. Huynh and Mr. Chung have no conflicts to disclose.
