Red eyelids: tips for facial and eyelid contact dermatitis
Updated: Jun 16
Why do I have red, itchy, flaky eyelids?
As a dermatologist, I've treated so many patients with red, itchy eyelids. This can--very understandably--be extremely uncomfortable, frustrating, and alarming.
While there are several causes of red, itchy eyelids, one of the most common is allergic contact dermatitis (ACD).
Here are a few key facts about ACD, which I'll review in more detail below.
ACD is one type of allergic skin reaction.
It often affects the eyelids, because the eyelids are one of the most sensitive areas of the body.
It can develop even in people who have never had skin problems before
Although the rash on your eyelids may have started suddenly, the redness can last a long time.
For some of my patients, their red itchy eyelids have been ongoing for weeks or even months.
Just to make it more complicated, ACD is a type of delayed allergy.
This means that after exposure to a trigger, it usually takes 2-3 days (on average) before the rash shows up
There are different possible triggers for eyelid ACD, and these are almost always external exposures (such as skin care products, airborne fragrances, and others)
Are my red eyelids due to a pollen allergy?
Pollen allergy often causes allergic conjunctivitis, with red, itchy eyes (specifically, red itchy eyeballs). Some people confuse allergic conjunctivitis with allergic contact dermatitis (ACD), but they're two very distinct conditions.
Allergic conjunctivitis affects the "whites" of your eyes, and is usually due to airborne pollens, animal dander, or similar allergens.
ACD, on the other hand, affects the skin AROUND the eyes, such as the eyelids.
ACD on the eyelids can be triggered by many different substances.
Although pollen allergy doesn't typically cause red itchy eyelids, there are a few cases where it might contribute. See below for more information on this.
If you develop red, itchy eyelids, it's important that you see your dermatologist, allergist, or ophthalmologist for an accurate diagnosis.
It's very important to see your physician for an accurate diagnosis. There are several different conditions that can cause a red, itchy rash on the eyelids.
What this means is that your testing and treatment recommendations will vary based on your diagnosis.
In this post, I'm focusing on allergic contact dermatitis of the eyelids.
This information will provide some guidance on what substances to avoid and how to avoid them.
As a dermatologist who specializes in allergic reactions of the skin, I can point you to the most common causes of eyelid allergic rashes.
I also have product recommendations that avoid the most common triggers of eyelid ACD.
What is allergic contact dermatitis (ACD)?
Why is it so hard to diagnose?
One of my friends developed an allergic reaction to her shampoo, and her case highlights why figuring out the cause of eyelid ACD can be so difficult.
First of all, this type of allergic reaction doesn't happen right away. You might use your shampoo, and even if you're allergic to it, it won't burn or sting right away. Instead, several days later you'll notice a rash.
Second, because eyelids are so sensitive, the offending agent may not be your eye products at all--it might actually be something you're using close by (like shampoo) or something in the air (such as essential oil diffusers) or something on your fingertips that has been transferred to your eyelids when you rub your itchy skin (such as nickel on your fingertips after you've lifted weights.)
Third, once the rash develops, it can take a long time for your skin to recover, even if you never use that product again. In fact, it can take as long as 8 weeks for the rash to go away.
Finally, the same chemicals may be used in many different products. So even if you switch shampoos, you may just be exposing yourself to the same exact trigger chemical.
What is allergic contact dermatitis?
ACD is a type of allergic reaction. In this type of allergy, a substance contacts the skin, and later results in a rash. The rash from poison ivy is one example. The rash classically occurs 2-3 days later, but it may happen just a few hours later, or one week later. This delay is what makes ACD so hard to figure out.
Once the rash occurs, it may last for weeks, and sometimes up to 8 weeks. People may stop using the offending product for 1-2 weeks, but that’s usually not long enough to see results.
What substances trigger ACD of the eyelid?
The eyelids are one of the most sensitive areas of the body. This means that they can react to:
Products that are used on the eyelid itself, such as eye drops or makeup.
Products that are used close by, such as facial products [soap, moisturizer] or hair products.
Substances that are on the hands and then transferred to the eyelids [when rubbing the eyelids or wiping away sweat], such as hand cream, plants, or even tiny metal particles.
Substances in the air, such as air freshener.
What are some of the most common substances that trigger ACD of the eyelids? How can I avoid them?
Fragrance additives and preservatives in skin and hair care products are some of the most common substances that trigger red, itchy eyelid rashes. The products listed below will avoid many of the most common triggers.
Chemicals in nail polish or artificial nails [acrylic, gel, shellac nails]. For many patients with eyelid ACD, we recommend stopping these completely for at least 8 weeks.
Hair dye chemicals. These can affect the eyelids, even if the scalp isn’t affected.
Antibiotic ointments or eyedrops, specifically neomycin, tobramycin, gentamycin, and bacitracin. If you are using any of these, you may need testing. You may also see if your doctor could prescribe an alternate. Note that erythromycin is an extremely rare cause of allergic reactions.
Preservatives in eyedrops. Testing is usually required to diagnose this allergy. Some persons, when possible, stop using the eyedrops temporarily. This can be tricky, though, because you would need to avoid the preservatives for 8 weeks to see if avoidance will help. Also, the common preservatives in eyedrops are often used in skin care products also.
Nickel, a type of metal used in eyeglass frames, jewelry, and other metal objects. If you’ve had rashes from jewelry, it may be best to switch to plastic eyeglass frames [including reading glasses and sunglasses].
Other substances, such as plants, cleaning chemicals, gloves, or other metals. It’s very important to keep your hands away from your eyelids. Obviously, most people rub their eyelids when they have a rash and itching, but in the process you can transfer tiny amounts of substances from your fingertips to your eyelids, and keep the rash going that way.
Are there any other substances that I need to be aware of that might trigger red, itchy eyelids?
Substances that cause Type 1 allergy may (sometimes) affect the eyelids. Type 1 allergy is the kind that most people know about. This occurs when pollens, pet dander, or dust mites trigger a runny nose, sneezing, or itchy eyes.
Now usually, this kind of allergy causes problems on the eyeballs themselves, not on the eyelids. That's because the eyelid skin forms a barrier, and those pollens or dust mites can't get through that skin barrier.
In some cases, though, pollen allergy can cause problems on the eyelids. I sometimes see this in patients with eczema, whose skin barrier isn't working correctly. In these patients, the pollen or dander is able to get through the skin barrier, and that can trigger the immune system reaction, with redness, swelling, and itching.
For example, when the pollen counts are high, and some of the pollen lands on the eyelids in someone with eczema, it can lead to redness, swelling, and itching. If you rub the eyelids frequently, then over time it can result in red, flaky, dry, inflamed patches of skin, also known as chronic dermatitis.
How can you prevent this from happening? If you’ve had allergy prick testing, then you should follow your Allergist’s recommendations. This may include wrap-around sunglasses to protect from pollens, and avoidance measures for dust mites, including pillow covers. And always try to keep your hands away from your eyelids so that you don't transfer pet dander or pollens or dust mites to the sensitive skin of the eyelids.
Can I treat my eyelid dermatitis with Vaseline?
If you're dealing with the red, flaking, itchy rash that goes along with eyelid dermatitis, you'll find that moisturizing your skin will help provide some relief. It's important to remember a few important points though.
Choose the right moisturizer. The wrong product may contain chemicals to which you are allergic, which would just keep the rash going.
Pure Vaseline petroleum jelly would be one good option, as long as it does not contain any added fragrance or flavorings. This is a really important point! I've had parents buy Vaseline in the baby aisle, and that version actually contains fragrance. (!)
I don't recommend Vaseline intensive care lotion, or any other lotion, to treat allergic reactions of the eyelids. Lotions contain a lot of water, and a lot of preservatives.
Another option would be 100% pure coconut oil
Note that although these moisturizers may help soothe the skin, they don't actually treat the inflammation.
If you have severe redness, flaking, and/or itching, see your physician. He or she will typically prescribe an anti-inflammatory cream or ointment to help calm down the skin inflammation of eyelid dermatitis
What products should I use?
You'll need to check with your physician on which products are recommended. I'm including several product recommendations below that may be options for many (although not all) individuals with ACD.
The products below do not contain any of the common triggers of ACD. They do not contain any synthetic fragrance additives, natural fragrance additives, botanicals, formaldehyde, methylchloroisothiazolinone, or lanolin.
Some are available at major retailers, and others must be ordered via phone or website.
Note that the ingredients of these products are accurate at the time of this article. Since product formulations often change over time, however, always check product labels prior to use, or check with your physician prior to use.
Also note that every product must contain some additives, and some people are allergic to less common substances. Therefore, if these recommendations do not help, then you may require further testing.
It can take up to 8 weeks of allergen avoidance for your skin to recover. You should check with your physician about a recommendation or prescription for a medicated ointment to use on your eyelids during this time to help with the inflammation.
Hypoallergenic soaps, cleansers, moisturizers, and shampoos
Eyelid cleansers: Albolene gentle cleanser [to remove make-up and as a cleanser for very sensitive skin]
Liquid cleansers: Cetaphil gentle skin cleanser [liquid only], Cerave hydrating or foaming cleanser, Free and Clear liquid cleanser
Bar soaps: Cerave hydrating bar soap, Neutrogena fragrance-free bar soap, Aveeno fragrance-free bar soap, Vanicream bar soap [1-800-325-8232]
Moisturizers for eyelids: Pure Vaseline petroleum jelly [no added fragrance or flavoring], Cerave healing ointment
Moisturizers: Aveeno Eczema Therapy cream, Cerave cream and lotion, Theraplex emollient, Vanicream cream and lotion
Hair Care [shampoo, conditioner, styling gel, hairspray]
Cleure hair care
Free and Clear hair care [1-800-325-8232]
Hello Seen Shampoo and Conditioner fragrance-free hair care [http://www.helloseen.com/]
VMV Hypoallergenics hair care [212-217 2762]
Laundry detergent: Branch Basics, Tide Free, All Free and Clear, or Cheer Free
Where can I find hypoallergenic makeup?
For people with sensitive skin, once your skin inflammation subsides, you'll be able to start wearing makeup again. For hypoallergenic makeup options, please see this list. A word of caution, though. Although these products contain fewer of the common allergic triggers, all products contain some potential triggers. Some patients will need patch testing to identify their allergic triggers.
Dr. Rajani Katta is the author of Glow: The Dermatologist's Guide to a Whole Foods Younger Skin Diet. To receive future updates on preventive dermatology and the role of diet, sign up here.