Contact dermatitis and eczema of the eyelids

Contact dermatitis and eyelid eczema are forms of the disease that occur significantly more often than many other allergic eye sufferings. Reflecting the response to a wide variety of external and internal factors, they differ from each other in certain features of the clinical picture and its dynamics. As a rule, these are manifestations of delayed-type allergy, which are acute (dermatitis) or acute and chronic (eczema). The intensity of clinical symptoms, their variability, the severity of the process are determined by the reactivity of the organism, the quality and quantity of allergens.

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Causes of contact dermatitis and eczema of the eyelids

The first place among those is taken by medicines that cause medicinal dermatitis and eczema (toxicermy): local anesthetics, mercury preparations, ointment bases, topically prescribed, parenterally and intravenously antibiotics, sulfonamides, salts of heavy metals, used in barbiturates, preparations of bromine, iodine, quinine , etc. In total they give more than 50% of all allergic lesions of the eyelids. On the second place from exogenous factors are cosmetic means: 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 eyeglass case, powder box, cigarette case, costume jewelery), industrial gases, dust, oils, solvents, etc. Photoallergic eczema is associated with ultraviolet irradiation. Patterned, irrational use of medicines, self-medication, excessive use of cosmetic, washing and other means, violations of industrial hygiene cause an increase in the frequency of allergic skin diseases of the eyelids, as well as other parts of the body.

Certain nutritional, epidermal, pollen, infectious allergens and auto-allergens have definite significance in the development of dermatitis and eczema of the eyelids. The appearance of pathology is facilitated by degreasing the skin of the eyelids, its microtraumas, cracks, maceration being detachable from the eye gap. Diseases often occur and are more severe in people suffering from other allergic diseases or predisposed to them, weighed down by diathesis, etc.

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Symptoms of contact dermatitis and eczema of the eyelids

Symptoms of the contact pathology of the eyelids are manifested more often not immediately after the stimulus, but after the incubation period, lasting from 6-14 days to several months and years. Many allergy becomes apparent only after repeated contacts with the allergen. The patient can use some medicine for years, and suddenly his intolerance comes.

Clinically contact dermatitis on various allergens is manifested by the developing acutely erythema of the eyelid skin, its edema, soreness, the eruption of minute papules and vesicles on the affected area. In severe cases, red, swollen, hot-to-touch eyelids narrow or completely cover the eye gap, conjunctiva hyperemia, lacrimation or serous discharge, skin cracks may appear at the outer corner of the eye gap. All this is accompanied by itching, a feeling of heat or burning and is often treated as acute eczema. The lesion is limited only to the skin of both the lower eyelid or to the skin of the face. The process is often two-sided. Repeated contact of the altered skin of the eyelids, even with a minimal dose of the allergen, causes the transition of dermatitis to eczema. Single-type when exposed to various allergens, the clinical picture is different at the same time, a large polymorphism of rashes. The patient is exacerbated by hyperemia, edema and vesiculation of the eyelid skin, maceration and mocculation occur, in the foci of which point pits are noted - eczematous or serous "wells", from which drops of serous exudate are excreted. Drying, the exudate turns into yellowish or whitish-gray crusts, and the stripped layer of the skin under them remains hyperemic and moist.

Of course, such a wealth of eczematous elements is not observed in every patient. The "blooming eczema" that was in the past a disaster for children and adults has now become rare even in ophthalmic and pediatric practice. In adults, however, eczema is much more frequent without efflorescence and mocclusion, confining itself to the formation of scales on the moderately hyperemic and edematic skin of the eyelids, clouding of the surface 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 like a burn.

Upon recovery, gradually contracting, the wetting areas are covered with crusts, epithelialization occurs beneath them, and the skin is completely restored. The sometime ending of eczema with cicatricial eyelid twitching, their deformation, even elephantiasis in modern conditions, can occur only in the case of extremely unfavorable course of the disease. The above-noted similarity of the eczema clinic is not absolute when exposed to various allergens. Depending on the nature of the stimuli AD Ado and co-workers. (1976) distinguish eczema true, microbial, occupational and seborrhoeic. A. Heidenreich (1975) describes endogenous, parasitic, scrofulous and seborrhoeic eczema of the eyelids. Mikulov (1966) pays special attention to microbial and fungal eczema, whereas Yu. F. Maychuk (1983) designates this pathology as "eczematous dermatitis" and only mentions it in the classification of medicinal 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, we can agree with this designation, although it is less informative than the concepts "dermatitis" and "eczema" used for many years.

Unlike the true "eczema of the eyelids," scrofulous and seborrhoea its forms manifest not only on the eyelids, but capture more extensive areas of the face and head skin, and in their clinical picture the eczematous elements are combined with the phenomena inherent in scrofululosis and seborrhea.

The significance of infection in pathogenesis and the eye clinic is twofold. On the one hand, microbes, a fungal infection, other microorganisms or products of their vital activity can be allergens that cause the development of eczema of the eyelids. The clinic of these specimens differs from another similar pathology only by a more precise delimitation of the affected skin from a healthy one, sometimes by the formation of a peculiar "fringe" of the detached epithelium along the edge of the focus. On the other hand, the infection can be layered on the eczematous process and give it a pyogenic character: on the eyelids there are purulent exudates and crusts. More often than other infectious agents in the eczematous diseases is involved Staphylococcus aureus. In addition to the specimen, it is known to cause eczemonous diseases of the eyelids, in particular ulcerative blepharitis.

Presenting a delayed-type allergy, eczema of the eyelids often occurs as a chronic inflammatory process, often with periods of significant improvement and relapses. With an average duration of the disease 4-5 weeks, rational treatment significantly accelerates recovery. On the contrary, new contacts with the allergen, diet disorders, nonspecific exogenous stimuli, mental stress, somatic pathology, unrecognized sources of endogenous allergens and autoallergens contribute to the fact that the treatment does not give the desired effect and the disease continues for many months. Emerging acute, but with limited eruptions and rapidly arresting irritations of the skin of the eyelids are often treated in the literature as acute eczema, although in essence they represent allergic dermatitis.

The pronounced uniqueness and uniformity of clinical manifestations of allergic dermatitis and eczema of the eyelids facilitate their nosological diagnosis, and skin tests with suspected antigens help to identify allergens, in addition to allergological anamnesis and clinical samples. Despite the seemingly limited damage to only the eyelids, the samples are often positive on the skin's outermost eyes.

In addition to eyelid eczema, allergic genesis of which is indisputable, it is possible to develop this pathology in patients with metabolic disorders (diabetes mellitus, gout, obesity), anemia, gastrointestinal diseases, ariboflavinosis, overfeeding of infants. Causes of irritation of the skin of the eyelids can also be separated from the eye gap in patients with conjunctivitis, constant lacrimation. However, in no such case it is impossible to exclude allergic factors, in particular autoallergens.