Eczema Complications series – Eye and Eyelid

This is a 4-topic series focused on complications from eczema and mainly inspired because my daughter recently had impetigo. Moreover, the potential complications from bacterial, viral and fungal infection are not very often emphasized yet a child with eczema is often vulnerable to infections. So let’s explore!

Eyelid Functions and Skin

The eyelid very often present a very tricky and difficult to treat skin area for eczema sufferers. Moreover, the constant rubbing and scratching of the eczema at the eyelid can also lead to complications. Before we go into the complications, let’s first understand the basics of eyelid functions and the skin at this delicate area.

Functions of the Eyelid

1. Protection from injury
2. Regulation of light
3. Maintenance and distribution of tear film/ flow

Eyelid Skin

The skin of the eyelid is characterized by:

1. Thinnest skin are of our body – total less than 1mm, with both the epidermis and dermis being the thinnest
2. Smoother skin due to finer hairs
3. Oilier skin due to more oil glands

Common Eyelid Conditions

Being thinner oilier skin and on the face predispose the eyelid to various health conditions, such as:

1. Atopic dermatitis (eczema), more common from adolescent age (read more from dermatologist Dr Lynn Chiam)
2. Contact dermatitis, due to contact with chemicals used on the face/eyes and hair
3. Seborrheic dermatitis, typically on the eyelid and eyebrow (read here for more on seborrheic dermatitis)
4. Blepharitis, also known as eyelid inflammation
5. Conjunctivitis – this refers to inflammation of the eyelid lining, accompanied by itching and eye watering
6. Ptosis, known as droopy eyelids from prolonged contact lens use or aging
7. Dermatochalasis, baggy eyes from aging
8. Ectropion, eyelids that roll outwards usually from ageing or sun-damaged facial skin
9. Entropion, eyelids that roll inwards, may also be complication of blepharitis
10. Malignant eyelid tumors
11. Chalazion, eyelid cyst swelling from obstruction of the meibomian (tear) gland, may also be complication of blepharitis
12. Hordeolum, also known as a stye, lump from infection of the meibomian gland, may also be complication of blepharitis

Eczema and Eyelid Complications

Apart from atopic, contact and seborrheic dermatitis of the eyelid, there are also complications from having eczema at the eyelid. Complications usually occur in patients with severe atopic dermatitis where repeated scratching and rubbing, inflammation and infection of the eyelid cause other conditions. Let’s take a closer look at some of these eczema eyelid complications:

Blepharitis

This refers to inflammation of the eyelid, being accompanied by redness, sore eyes, itch, flakiness, burning, swelling, eye watering and mucous discharge. The eyelid margin may appear crusty, waxy or greasy. Blepharitis can be due to many reasons, including allergy, irritation and bacteria infection that causes the eyelids to become itchy. Blepharitis is associated with eczema, rosacea and acne patients.

Relation of Blepharitis to eczema as follow:

a)     Staphylococcal blepharitis – patients with eczema have higher chance of staphylococcus bacteria colonization, leading to staph bacteria infection

b)    Seborrheic blepharitis – due to the malfunction of oil glands at the eyelid, affecting patients with seborrheic dermatitis. The excess oil production may be due to stress, hormonal changes or diet. A characteristic of seborrhea blepharitis is redness at the eyelid throughout the day and crusting at eyelid in the morning.

c)     Other eczema complications – Complications of eczema such as from herpes simplex or varicella zoster virus or molluscum contagiosum can also cause blepharitis.

Dennie-Morgan fold

This refers to a fold under the lower eyelid, typically due to excessive scratching/rubbing of the eye. The eyelid may also hyper-pigment or become red and swollen.

Allergic Contact Dermatitis

Ophthalmic corticosteroids may also product allergic contact dermatitis, due to allergy from certain ingredients of the corticosteroids.

Eyelid Erythema

This refers to redness of the eyelids and can be caused by eczema, contact dermatitis and blepharitis.

Cellulitis

This refers to bacterial infection of the eyelid and can also be caused by insect bite/ other skin injury. Preseptal cellulitis affects the eyelid and skin around the eye, but not the eye socket. Orbital Cellulitis is much more severe and affects the back of the eye, causing eye protrusion and double vision. The common bacteria causing cellulitis are Haemophilus influenzae, Staphylococcus and Streptococcus.

Neurodermatitis

Also known as lichen simplex chronicus, this refers to skin thickening, lichenification of the skin of the eyelid from habitual scratching.

Eczema and Eye Complications

There are also complications involving the eye, typically for prolonged eczema at the eyelid.

Keratoconus – This refers to the degeneration of cornea which pushes the eye outward, resulting in a cone shaped eyeball. There will be visual disturbance with this condition. This may be due to hard rubbing of the eye from the itch.

Scarring – This refers to scarring of the eye, mostly due to scratching or excessive rubbing.

Cataract – There is association between cataract and severe and chronic atopic dermatitis of more than 10 years, possibly due to overtime absorption of steroid cream applied on thin eyelid. One feature of cataracts associated with eczema is that the cataract affects both eyes.

Retinal detachment – This is very rare and associated with severe atopic dermatitis.

Complications from prescription creams seeping into the eyes, resulting in glaucoma

Certain eye-related conditions are not directly related to eczema, but related to allergy. For instance, conjunctival irritation

General Care for the Eyelid (Hygiene)

Top tips for general care of the eyelid:
1. Refrain from eye make-up
2. If wearing contact lens, always clean with disinfectant solution; in certain cases, refrain from using contact lens.
3. Apply warm (not hot) compress 4 times a day to clean and reduce discomfort (for blepharitis)
4. Clean eyelid with cotton swab with mild diluted baby shampoo/wash (read dermatologist Dr Jessica Krant’s tips for baby’s eyelid here)
5. Use artificial tears as blepharitis commonly occurs alongside dry eyes
6. An omega-3 supplement may be recommended to patients with blepharitis as small-scale study suggested anti-inflammatory effect of omega 3 benefit blepharitis patients. More on omega 3 and eczema here.

As you can see, there are quite a lot of health conditions affecting the eyelid and a few relating to eczema. Most of it has to do with bacteria and scratching, thus it is important to practice eyelid hygiene and treating conditions that create itch at the eye promptly.

note: if you’ve reached this far to the post, thank you! Took me a long time to do up a comprehensive post on eyelid complications from eczema and if you have any to share, kindly comment, will make my day!