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Symptoms

Sudden onset of a periorbital rash, usually pruritic, and/or eyelid swelling.

Signs

Critical

Periorbital edema, erythema, vesicles, and lichenification of the skin. Conjunctival chemosis out of proportion to injection and papillary response (see Figure 5.11.1).

5-11.1 Contact dermatitis.

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Other

Watery discharge; crusting of the skin may develop.

Differential Diagnosis

Etiology

Most commonly eye drops and cosmetics.

Treatment

  1. Avoid the offending agent(s).
  2. Cool compresses four to six times per day.
  3. Preservative-free artificial tears four to eight times per day and topical antihistamines (e.g., levocabastine 0.05% q.i.d.).
  4. Consider tacrolimus 0.03% to 0.1% q.h.s. or b.i.d. (preferred).
  5. Consider a mild steroid ointment (e.g., fluorometholone 0.1%, or loteprednol 0.5%) applied to the periocular area b.i.d. to t.i.d. for 4 to 5 days for skin involvement.
  6. Consider an oral antihistamine (e.g., diphenhydramine 25 to 50 mg p.o. t.i.d. to q.i.d.) for several days.

Follow Up

Re-examine within 1 week.