Red eyelids: tips for facial and eyelid contact dermatitis
Updated: Aug 16, 2020
You may have woken up one morning with red, itchy eyelids. This can be alarming and very uncomfortable. Even more so if the redness persists for weeks or months, as has happened for many of my patients.
While there are several causes of red, itchy eyelids, one of the most common is allergic contact dermatitis (ACD). ACD often affects the eyelids, because the eyelids are one of the most sensitive areas of the body.
Some people may confuse allergic conjunctivitis with allergic contact dermatitis. Allergic conjunctivitis affects the "whites" of your eyes, and is usually due to airborne pollens, animal dander, or similar allergens. ACD affects the skin around the eyes. ACD on the eyelids can be triggered by many different substances.
If you do wake up with red, itchy eyelids, it's important that you see your dermatologist, allergist, or ophthalmologist for an accurate diagnosis.
If your physician has diagnosed you with allergic reactions of the eyelid, the information below will provide more guidance on what substances to avoid and how to avoid them.
What is allergic contact dermatitis (ACD)?
Why is it so hard to diagnose?
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. 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?
Substances that cause Type 1 allergy may 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. In some people with sensitive skin, the same substances can also cause a rash. For example, when the pollen counts are high, and some of the pollen lands on the eyelids, it can lead to redness, swelling, and itching. If you rub the eyelids, then over time it can result in chronic dermatitis.
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.
What products should I use?
Check with your physician on which products are recommended.
Note that 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 may 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.
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]
Magick Botanicals fragrance-free hair care [1-800-237-0674]
VMV Hypoallergenics hair care [212-217 2762]
Laundry detergent: Branch Basics, Tide Free, All Free and Clear, or Cheer Free
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.