The eyes and atopic eczema

author/source: DrB & DrN




Any cause of itchy eyes - invariably inflammation of the eyelids and the underlying conjunctiva (the outer lining of the eye itself) - can lead to habitual eye rubbing, which in turn can then lead to

  •  thichened folds of skin of the eyelids (see illustration above: Dennie-Morgan folds) and
  •  blepharitis - infection of the eyelash roots

More importantly perhaps, chronic rubbing the eyes over time is also associated with the development of diseases of the eye itself, including

  •  glaucoma - raised intra-ocular pressure, and
  •  keratoconus - thinning and deformity of the cornea

Atopic eczema of the eyelids is a cause of habitual eye rubbing. The effective use of The Combined Approach treatment programme avoids the long term effects above. The usual three levels of treatment are recommended:

Level 1: Emollient

              For each application a tiny amount of petroleum jelly (Vaseline) is recommended, especially when rubbed between warm fingers before it is applied. Otherwise, for example, Avène eyelid moisturiser is also recommended.

Level 2: Topical Steroid

              Eczema of the eyelids needs treatment with appropriate topical steroids: this needs care however, if long term side effects are to be avoided - medical supervision is recommended. Short term use of moderate strength topical steroid, even potent strength topical steroid, as part of The Combined Approach, may be the optimal treatment. Any cream that often causes stinging - usually caused by preservative - should be discontinued. 

Level 3: Habit reversal

              Topical treatment without behaviour modification can have disappointing results. Combining habit reversal with emollient and topical steroids over a few weeks is likely to give the best results, as with atopic eczema affecting the skin elsewhere.

Otherwise: allergic conjunctivitis can be a real problem, and may require getting rid of the cat, or covering the house dusty pillow! Anti-histamines by mouth, disodium chromoglycate eye drops and Betnesol Eye Drops are sometimes required, with The Combined Approach if the condition has become chronic.

What has your experience been?