Eyelid dermatitis is an inflammatory lesion of the skin of the eyelids. The main symptoms of the disease are burning, itching, specific rashes, hyperemia and edema. Laboratory methods (ELISA, PCR, determination of the IdE level, general blood analysis, histological examination of the biopsy) and instrumental methods of examination (biomicroscopy) are used for diagnosis. Depending on the etiology of the disease, treatment tactics are reduced to the use of antibacterial agents, H2-histamine blockers, glucocorticosteroids, antiviral drugs or calcineurin inhibitors
Eyelid dermatitis is a common pathology in which there is an isolated lesion of the eyelid skin or its combination with similar skin manifestations of other localizations. According to statistics, every tenth person has noted symptoms of this disease throughout his life. In the structure of the general incidence of dermatitis, the eyelids and the periorbital region are affected in 27% of cases. Usually, the upper eyelids are involved in the pathological process. Seborrheic form develops more often in young women, which is associated with vegetoneurosis. There is no epidemiological information on the prevalence of the disease.
Causes of eyelid dermatitis
Inflammation of the skin of the eyelids and the ocular region is a pathological reaction that occurs in response to the effects of many exogenous and endogenous factors. It is not always possible to establish the etiology. Atopic reactions play a leading role in childhood. The main causes of the development of pathology:
- Infectious diseases. Most often, the appearance of symptoms of dermatitis is associated with infection with the herpes simplex virus or herpes zoster. Secondary inflammation of the skin is detected in patients with measles, chickenpox, scarlet fever.
- Allergic reactions. Medicines, food, pollen, animal hair, etc. act as allergens. Inflammatory manifestations are also found in other parts of the body. A local lesion of the eyelids is characteristic of allergies to cosmetics.
- The impact of physical factors. The disease may be the result of excessive insolation or a reaction to cold. Cases of radiation damage under the influence of ionizing radiation are also described.
- The influence of chemicals. Pathological changes develop when household chemicals accidentally get on the skin or due to prolonged contact of the eyelid skin with chemicals in production conditions with non-compliance with safety regulations.
- Violation of the functions of the sebaceous glands. The increased production of sebum by the sebaceous glands creates favorable conditions for the occurrence of seborrheic dermatitis.
When infected with the herpes simplex virus, the appearance of clinical symptoms is due to the dermato-, meso- and neurotropic action of the pathological agent. In patients with a history of drip infections (measles, chickenpox, scarlet fever), dermatitis is a secondary pathology that develops due to the addition of bacterial flora or an atopic reaction to local antiseptics. In the pathogenesis of the seborrheic form of the disease, the leading importance is given to the violation of the nervous and neuroendocrine dysfunction of the sebaceous glands. Often, the first symptoms occur against the background of hormonal imbalance, including hormonal adjustment in the puberty period.
The allergic variant of the disease is caused by an immediate or delayed hypersensitivity reaction, which is determined by the type of sensitization of the body. With the immediate type, signs are detected 15-30 minutes after exposure to the trigger and completely disappear after 1-2 hours. With the delayed type, clinical symptoms develop after 6-12 hours, external changes are leveled only after a few days or weeks. The skin of the palpebral zone is most sensitive to the adverse effects of physical factors. This is due to anatomical and physiological features of the structure (thin skin-muscle and conjunctival-cartilaginous layers).
With herpetic origin, the disease develops acutely. Against the background of hyperemia of the skin of the face and eyelids, small bubbles filled with transparent contents appear. Patients note that specific elements of the rash are formed against the background of general hyperthermia. Their formation is preceded by a burning sensation and itching in the periorbital zone. Over time, dry crusts form in place of the bubbles, which disappear without a trace after 2 weeks. The herpetic form is characterized by a high tendency to relapse. If the etiological factor is infection with herpes zoster virus, then the clinical picture is dominated by complaints of severe pain in the area of rashes. The elements of the rash are located along the nerve fibers.
With allergic dermatitis, patients complain of swelling and hyperemia of the palpebral region. Vesicular, rarely bullous rash is found on the skin. Due to severe swelling, the patient often cannot open his eyes. Maceration of the skin is observed in the corners of the eye slit. With a delayed version of hypersensitivity, the skin gradually thickens and becomes drier. Then a spotty or papulovezykular rash appears. With a severe course of the allergic process, angioedema of the ocular zone (Quincke’s edema) develops, often spreading to the surrounding tissues: nose, lips, cheeks.
With seborrheic origin of pathology, patients note greasy shine, peeling of the skin and loss of eyelashes. The stratum corneum of the epidermis is thickened. Skin itching occurs early. The first to be affected is the anterior palpebral margin, which is due to the location of the sebaceous glands at the roots of the eyelashes. Further, signs of dermatitis are detected in the area of the cheekbones, wings of the nose, forehead. Often, the pathological process spreads to the skin of the scalp. Atopic dermatitis of the eyelid is characterized by the appearance of foci of hyperpigmentation. In children, an additional fold of the lower eyelid is often formed (Denier-Morgan symptom).
The complicated course is characteristic of the formation of pustules and vesicles on the skin of the eyelids. The opening of the bubbles is often accompanied by their infection. Frequent outcomes of the disease are acute blepharitis and blepharoconjunctivitis. The formation of erosive defects is complicated by the formation of dense keloid scars and deformation of the eyelid. Patients note a violation of the function of closing the orbital slit. Persons with dermatitis are at risk of developing inflammatory complications of the anterior segment of the eyes (keratitis, keratoconjunctivitis). In rare cases, the formation of an abscess of the eyelid is observed.
If dermatitis is suspected, a physical examination is performed, specific diagnostic methods are prescribed. With the help of biomicroscopy of the eye using a slit lamp, hyperemia, swelling of the eyelids and pathological rashes are determined, the nature of which depends on the etiology of the disease. In the presence of herpetic vesicles, their puncture is indicated with further microscopic analysis of the contents. Laboratory research methods include:
- A general blood test. With the viral nature of the pathology, a shift of the leukocyte formula to the right is detected. The bacterial origin of the disease is indicated by the shift of the formula to the left. The level of ESR is higher than normal.
- Enzyme immunoassay (ELISA). The study is used for the infectious nature of the disease. The titer of Ig M is increased by 4 or more times, which indicates an acute form of pathology. The increase in the Ig G titer indicates a chronic course.
- Polymerase chain reaction (PCR). The method makes it possible to identify the genetic material (DNA, RNA) of the pathogen in the blood. This is the most informative technique for the viral origin of dermatitis.
- Determination of immunoglobulin E. IdE in the blood is a marker of immediate hypersensitivity. An increase in its titer in the blood serum indicates the development of an allergic reaction.
- Histological examination. Histology of the biopsy is carried out with seborrheic lesion. Follicular plugs, perivascular infiltrate consisting of lymphocytes and histiocytes are visualized.
Treatment of eyelid dermatitis
Therapeutic tactics of eyelid dermatitis are determined by the etiology of the disease. With a herpetic form, the bubbles on the eyelids are smeared with an ointment containing acyclovir in its composition. Medications should be applied when the first clinical symptoms appear. In addition to local treatment, the use of immunotherapeutic drugs (recombinant interferon, immunomodulators) is indicated. The duration of the course is 10-14 days. 1-2 months after the relief of symptoms, the introduction of a herpetic vaccine is recommended to achieve stable remission.
The first stage in the treatment of allergic dermatitis is the elimination of the etiological factor. Patients are shown the use of antihistamines. Corticosteroid ointments are applied to the skin of the eyelids. With a complicated course, hormonal drugs are prescribed in a short course. In seborrheic genesis of the disease, topical glucocorticosteroids are used in combination with calcineurin inhibitors. In the case of a pronounced inflammatory reaction, anti-inflammatory drugs are used in the form of lotions. To prevent the development of bacterial complications, 1-2% alcohol solutions of aniline dyes are applied to the palpebral zone. With severe itching, H2-histamine blockers are additionally shown.
Prognosis and prevention
With timely treatment, the prognosis is favorable. Specific preventive measures have not been developed, non-specific ones are aimed at preventing contact with an etiological factor. When working with industrial chemicals, it is necessary to use personal protective equipment (glasses, mask). Patients with a history of recurrent herpes infection with the development of the first symptoms (itching, burning) should apply a drug to the eyelid without waiting for the rash to appear. With seborrheic nature, the main attention should be paid to the correction of hormonal dysfunction.