About eczema around the eyes

There are a number of conditions (e.g. blepharitis and allergic conjunctivitis) and types of eczema (e.g. contact dermatitis and seborrhoeic dermatitis) which affect the eye and the eye area. These occur more commonly in people with eczema elsewhere on the body – usually those with atopic eczema and related conditions (asthma and hay fever).

The eyelid skin of children with atopic eczema is often affected by eczema. Eyelid eczema is also common in adults with eczema elsewhere on the face. Seborrhoeic dermatitis of the eyelids tends to affect just the eyelid margins and is seen more frequently in adults. The itchy, red, dry, scaling skin of eyelid eczema is particularly problematic for all ages as the skin is very thin and sensitive here.

How is it treated?

Eyelid eczema is treated with emollients and mild topical steroids, prescribed by your doctor or other health professional. Generally, only mild topical steroids (0.5-1% hydrocortisone) are recommended for eyelid eczema, because strong topical steroids can cause thinning of the skin around the eye – an area where the skin is already thinner than on other parts of the body.

Mild topical steroids are safe to use as long as you follow your doctor’s instructions. Sometimes for a severe flare a stronger steroid may be prescribed (usually Eumovate, a moderate topical steroid) for a short treatment burst of around 5 days and then stepped down to a mild steroid. Anything more potent than a moderate topical steroid would only be prescribed by a dermatologist for use on the eyelids.

Topical calcineurin inhibitors (TCIs) – pimecrolimus (Elidel) or tacrolimus (Protopic) – are also prescribed for eyelid eczema. These are not steroids so there is no problem with them thinning the skin, though they can have some other side effects. These include photosensitivity, so as it is difficult to use sunscreen on the eyelids, they are best applied in the evening; or if applied in the day, a sun hat and sunglasses should be worn, especially from March to September.

TCIs are initially prescribed for 6 weeks and can also be used for long-term, twice-weekly maintenance treatment. It is common for TCIs to produce a burning and stinging sensation when first put on, but this usually subsides after a few days, so try to persevere.

We recommend that you keep facial skin care simple and use bland medical leave-on emollient to wash with, as well as applying it frequently as a moisturiser. You should definitely avoid washing your face with soap or using perfumed face creams. It is important not to use olive oil or aqueous cream on your eyelids as these are both known to damage the skin barrier in eczema. You can also use your emollient to remove eye make-up including mascara.

For more information on eczema around the eyes, please see our Eczema around the eyes factsheet