Contact dermatitis and eyelid eczema

Contact dermatitis and eyelid eczema are forms of the disease that occur much more frequently than many other allergic eye diseases. Reflecting the reaction to a variety of external and internal factors, they differ from each other in some features of the clinical picture and its dynamics. As a rule, these are manifestations of a delayed-type allergy, occurring acutely (dermatitis) or acutely and chronically (eczema). The intensity of clinical symptoms, their variability, and the severity of the process are determined by the reactivity of the body, the quality and quantity of allergens.

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Causes of Contact Dermatitis and Eyelid Eczema

The first place among such are occupied by medications causing drug dermatitis and eczema (toxidermias): locally applied anesthetics, mercury preparations, ointment bases, antibiotics prescribed locally, parenterally and orally, sulfonamides, salts of heavy metals, orally applied barbiturates, preparations of bromine, iodine, quinine, etc. In total, they give more than 50% of all allergic lesions of the eyelids. In second place among exogenous factors are cosmetics: paint for eyelashes, eyebrows and nails, creams, powder, lotions, some types of soap. Dermatitis and eczema of the eyelids can also be caused by detergents, plastic products (frames or cases for glasses, powder compacts, cigarette cases, costume jewelry), industrial gases, dust, oils, solvents, etc. Photoallergic eczema is associated with ultraviolet radiation. Routine, irrational use of medications, self-medication, excessive use of cosmetics, detergents and other products, violations of industrial hygiene cause an increase in the frequency of allergic pathology of the skin of the eyelids, as well as other parts of the body.

Certain significance in the development of dermatitis and eczema of the eyelids is played by food, epidermal, pollen, infectious allergens and autoallergens. The occurrence of pathology is facilitated by degreasing of the skin of the eyelids, its microtraumas, cracks, maceration by discharge from the eye slit. Diseases occur more often and are more severe in people suffering from other allergic diseases or predisposed to them, burdened with diathesis, etc.

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Symptoms of Contact Dermatitis and Eyelid Eczema

Symptoms of contact eyelid pathology often appear not immediately after exposure to an irritant, but after an incubation period lasting from 6-14 days to several months and years. For many, the allergy becomes obvious only after repeated contacts with the allergen. A patient can use a certain medicine for years, and suddenly develop intolerance to it.

Clinically, contact dermatitis to various allergens is manifested by developing acute erythema of the skin of the eyelids, its edema, soreness, a rash of tiny papules and vesicles on the affected area. In severe cases, red, edematous, hot to the touch eyelids narrow or completely close the eye slit, hyperemia of the conjunctiva, lacrimation or serous discharge appear, cracks in the skin at the outer corner of the eye slit may occur. All this is accompanied by itching, a feeling of heat or burning and is often interpreted as acute eczema. The lesion is limited only to the skin of both or the lower eyelid or extends beyond them to the skin of the face. The process is often bilateral. Repeated contact of the changed skin of the eyelids with even a minimal dose of the allergen causes the transition of dermatitis to eczema. The clinical picture, uniform when exposed to various allergens, is distinguished at the same time by a high polymorphism of rashes. The patient experiences increased hyperemia, edema and vesiculation of the skin of the eyelids, its maceration and weeping occur, in the foci of which point depressions are noted - eczematous or serous "wells", from which drops of serous exudate are released. When drying, the exudate turns into yellowish or whitish-gray crusts, and the skin under them, deprived of the horny layer, remains hyperemic and moist.

Of course, such a wealth of eczematous elements is not observed in every patient. The "flowering eczema" that used to be a disaster for children and adults has now become rare even in ophthalmopediatric practice. In adults, eczema much more often occurs without efflorescence and weeping, limited only to the formation of scales on moderately hyperemic and edematous skin of the eyelids, clouding of its superficial layers. However, if the essence of the process remains unrecognized, contact with the allergen continues, then the course of the disease worsens and in severe cases the lesion becomes similar to a burn.

During recovery, gradually shrinking, the wet areas become covered with crusts, epithelialization occurs under them, and the skin is completely restored. The once frequent completion of eczema with cicatricial eversion of the eyelids, their deformation, even elephantiasis can now be found only in extremely unfavorable cases of the disease. The above-mentioned uniformity of the clinical picture of eczema under the influence of various allergens is not absolute. Depending on the nature of the irritants, A. D. Ado et al. (1976) distinguish between true, microbial, professional and seborrheic eczema. A. Heidenreich (1975) describes endogenous, parasitic, scrofulous and seborrheic eczema of the eyelids. I. I. Merkulov (1966) pays special attention to microbial and fungal eczemas in his manual, while Yu. F. Maychuk (1983) designates this pathology as "eczematous dermatitis" and only mentions it in the classification of drug allergies of the eye. According to this author, the most common form of allergic lesions of the skin of the eyelids is dermatoconjunctivitis. Since the conjunctiva is always involved in the pathological process to some extent in allergies, one can agree with this designation, although it is less informative than the concepts of "dermatitis" and "eczema" that have been used for many years.

Unlike true "eczema of the eyelids", scrofulous and seborrheic forms appear not only on the eyelids, but also affect larger areas of the skin of the face and head, and in their clinical picture, eczematous elements are combined with phenomena characteristic of scrofulosis and seborrhea.

The significance of infection in the pathogenesis and clinical picture of eye eczemas is twofold. On the one hand, microbes, fungal infection, other microorganisms or their waste products can be allergens that cause the development of eyelid eczema. The clinical picture of these eczemas differs from other similar pathologies only by a clearer demarcation of the affected skin from the healthy one, sometimes by the formation of a kind of "fringe" of exfoliated epithelium along the edge of the lesion. On the other hand, infection can be superimposed on the eczematous process and give it a pyogenic character: purulent exudate and crusts appear on the eyelids. Staphylococcus aureus is the most common infectious agent in eczematous diseases. In addition to eczema, it is known to cause eczema-like diseases of the eyelids, in particular ulcerative blepharitis.

Being a delayed-type allergy, eyelid eczema often occurs as a chronic inflammatory process, often with periods of significant improvement and relapses. With an average disease duration of 4-5 weeks, rational treatment significantly accelerates recovery. On the contrary, new contacts with the allergen, dietary violations, non-specific exogenous irritants, mental stress, somatic pathology, unrecognized sources of endogenous allergens and autoallergens contribute to the fact that treatment does not give the desired effect and the disease continues for many months. Acutely occurring, but with limited rashes and quickly relieved irritations of the skin of the eyelids are often interpreted in the literature as acute eczema, although in fact they represent allergic dermatitis.

The pronounced uniqueness and uniformity of clinical manifestations of allergic dermatitis and eyelid eczema facilitate their nosological diagnosis, and skin tests with suspected antigens help to identify allergens, in addition to the allergological anamnesis and clinical tests. Despite the seemingly limited damage to the eyelids only, the tests often turn out to be positive on skin distant from the eyes.

In addition to eyelid eczema, the allergic genesis of which is indisputable, this pathology may develop in patients with metabolic disorders (diabetes mellitus, gout, obesity), anemia, gastrointestinal diseases, ariboflavinosis, and overfeeding of infants. Causes of eyelid skin irritation may also be discharge from the eye slit in patients with conjunctivitis, constant lacrimation. However, in none of these cases can allergic factors, in particular autoallergens, be excluded.