Contact Dermatitis of the Eyelids

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In contradistinction to ocular allergy, which is predominantly associated with the activation of mast cells, contact dermatitis is predominantly a lymphocytic delayed type of hypersensitivity reaction involving the eyelids. Because the eyelid skin is soft, pliable, and thin, contact dermatitis of the eyelids frequently causes the patient to seek medical attention for a cutaneous reaction that elsewhere on the skin normally would be of less concern. The eyelid skin is capable of developing significant swelling and redness with minor degrees of inflammation.

contact dermatitis of the lids and periorbital area more often is caused by cosmetics applied to the hair, face, or fingernails than by cosmetics applied to the eye area. It is important to bear in mind that the sites to which some of these cosmetics are applied may not be affected. This is particularly true for hair dye (Fig. 2) and nail polish. Preservatives such as thimerosal found in contact lens cleaning solutions have been shown by patch tests to be major culprits. Stinging and burning of the eyes and lids are the most common complaints. These subjective symptoms are usually transitory and unaccompanied by objective signs of irritation. Two principal forms of contact dermatitis attributable to eye area cosmetics are recognized: allergic contact dermatitis and irritant (toxic) contact

Thimerosal Allergy Reaction
Fig. 2. Angioedema around the eyes 24 h after exposure to hair dye. Patient had a similar reaction to hair dye 2 mo previously.

dermatitis. Most common irritants are found in water-based mascara that usually contains emulsifiers such as sodium borate and ammonium. These "water-based" emulsifiers can be irritating the conjunctival surfaces in certain individuals who may otherwise tolerate an anhydrous, waterproof mascara. The patch test can assist in pinpointing the causative antigen, but interpretation of patch-test results may consequently be difficult, and the likelihood of irritant false-positive reactions must be borne in mind.

Contact allergy is a common cause of eyelid dermatitis in particular, and the allergens may reach the skin in many different ways. Common sources for allergenic sensitizers are topical pharmaceutical products (antibiotics, corticosteroids), cosmetics (fragrance components, preservatives, emulsifiers, hair-care and nail products), metals (nickel), rubber derivatives, resins (e.g., epoxy resin), and plants. Also, latex allergy (immediate-type sensitivity presenting as a contact-urticaria syndrome) was a frequent finding in such patients.

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