Atopic eczema on the eyelids – Causes, symptoms and treatment for eczema around eyes

Atopic dermatitis (AD) – also known as atopic eczema – is a chronic (persistent or long-term) skin disease characterised by dry, flaky and itchy skin. It can appear anywhere on the body and can flare up on the face. With this condition, the top layer of skin struggles to protect you against things like allergens or irritants, and doesn't retain adequate moisture.

This article focuses on atopic dermatitis on and around the eyelids, referred to as eyelid dermatitis or eyelid eczema. It explains how to recognise the symptoms  if you or your child have it, and looks at the possible causes and triggers. Learn how to care for atopic skin on a daily basis, and specifically treat eyelid dermatitis with an eye cream for eczema.

If the skin around your eyes is dry, red and itchy then you may have atopic dermatitis. This affects one or both of the eyes. People with eczema on the eyelids generally experience the following symptoms:

• scaling skin
• swelling
• pain or burning sensation
• rash under the eye(s)
• raised or weeping bumps
• red, brown, or grey patches
• thick, cracked, or creased appearance
• sensitivity caused by scratching

Eyelid irritation can be managed by avoiding triggers and using the right treatment. Eczema on eyelids can become a long-term condition however. If you are in any doubt about your symptoms, we advise that you consult your doctor who will be able to give you a full diagnosis and advice. Eczema around the eyes can easily be mistaken for dark circles around the eyes.

Those who have had eczema diagnosed since early childhood are more likely to suffer from eyelid eczema. So if you or your child already experience atopic dermatitis on other areas of your body, then it is likely that the symptoms around your eyes are linked. A family history of atopic dermatitis is a factor, and it is more common in people with sensitive skin. Facial atopic dermatitis is especially common in babies and children, but many adults have it too.

If you or your child do not have atopic dermatitis then there are several other types of dermatitis that are also common in the eye area, and which present very similar symptoms. These include:

• Seborrheic dermatitis (or seborrheic eczema): This type of dermatitis, thought to be caused by a reaction to yeast on the surface of skin, can also affect the margins of the eyelid. Skin appears red with yellow flakes but is rarely itchy. It usually occurs on the scalp, but is also present in oily areas of skin, like the eyelids. Seborrheic dermatitis can affect both children and adults but, when it appears in the eye area, it is normally adults who are affected.
• Contact dermatitis: Common on the hands, contact dermatitis is a red and irritating rash caused by an allergic reaction to something that the skin is, or has been, in contact with. The most common form of contact dermatitis in the eye area is caused by an allergic reaction to nail polish, which occurs when people wearing polish rub their eyes, but other types of make-up, or metals such as nickel, can also cause sensitivity or a rash under eyes.

You can learn more about other types of eczema that you can get. By being aware of the type of eczema you have, you can provide the right treatment for it.

You can find out more about atopic dermatitis, including how it affects babies, children and adults, or about how the symptoms differ on different parts of the body, on the Eucerin website:

• Facial atopic dermatitis
• Atopic dermatitis on the scalp
• Atopic dermatitis on the hands
• Atopic dermatitis on different parts of the body

Atopic dermatitis often forms around the eyes because the skin around our eyes and on our eyelids is particularly delicate: it’s about three times thinner than the rest of the skin on our face. The eyelids contain many blood vessels, but barely any fat, which makes them particularly susceptible to drying out, irritation and allergic reactions.

Once skin in this area has become dry and irritated, scratching makes the symptoms much worse, as the skin in the eye area is so easily damaged. You can find out more about the general causes and triggers here.

If you suffer from eyelid dermatitis, it is important to try and identify any triggers, contact irritants and allergens that can cause eczema flare-ups. These can range from certain make-up products, perfumes or sunscreens to things like eye drops, false eyelashes or swimming goggles. There are many potential allergens and irritants in the environment, so it might not be easy to identify your triggers, but keeping track of these in a journal may help you discover the cause of your eyelid irritation.

Atopic dermatitis has two distinct phases. On a daily basis and in the periods between flare-ups use gentle, fragrance-free eye make-up removers, cleansers and moisturisers. Try to avoid cosmetic products that contain fragrances and preservatives as these may irritate your skin.

During the acute phase when skin flares-up, a non-medical product such as Eucerin AtoControl Face Care Cream can be used as an eye cream for eczema alongside a medical product to soothe skin during a flare-up.

As well as using a dry eyelids cream, ask your doctor for advice on how to calm and care for skin in the eye area during a flare-up. Your doctor may prescribe corticosteroids to treat eczema on eyelids and relieve symptoms. These steroid-based creams are applied directly to the eyelids to reduce dryness and treat inflammation.

Typically, only mild topical steroids are recommended for eczema on eyelids because strong steroids can lead to thinning of the skin. For this reason, they’ll likely only prescribe this treatment for a short period of time. Generally, the strength of the medication depends on the severity of the symptoms.

Topical calcineurin inhibitors (TCIs) are another form of treatment for inflammatory disorders, including eczema on eyelids and psoriasis. This medication can be taken orally or applied as cream. TCIs aren’t steroids so there is no risk of thinning the skin, but they should be taken with caution as they can suppress the immune function, while another side effect is photosensitivity.

As explained, the causes and triggers of eczema on eyelids can vary. Eyelid eczema may not pose any serious health risks, but the condition can interfere with daily life. Follow the tips below to help reduce the chance of future flare-ups, baring in mind that some actions will be more effective for your skin than others.

Read more about the possible triggers of a flare-up, as well as how to soothe and care for atopic skin during a flare-up here.

• Moisturise your eyes regularly as part of your skincare routine, taking care not to get the product in the eyes. Eucerin UreaRepair Replenishing Face Cream is a light and gentle everyday moisturiser for dry to very dry skin.
• Avoid rubbing or scratching your eyes, as this can cause further irritation and increase the risk of infection.
• Keep your eyelids and hands clean, but try to keep your hands away from your eyes as much as possible.
• Limit make-up use around the eyes - products such as mascara or eye shadow can irritate the sensitive skin around the eyes - or switch to hypo-allergenic brands.
• If you spend a lot of time outside, consider wearing glasses or goggles to shield your eyes from potential irritants.
• Reduce the length of your showers or baths to limit the time skin is exposed to possible irritants and strong soaps.
• Test anti-itching products like over-the-counter medications.
• Use a cold or warm compress to soothe itchy eyes.
• Food allergies can trigger eyelid dermatitis, so consider dietary changes such as cutting out dairy products. Consult your doctor before making significant changes to your diet.