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.
Other
Watery discharge; crusting of the skin may develop.
Preservative-free artificial tears four to eight times per day and topical antihistamines (e.g., levocabastine 0.05% q.i.d.).
Consider tacrolimus 0.03% to 0.1% q.h.s. or b.i.d. (preferred).
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.
Consider an oral antihistamine (e.g., diphenhydramine 25 to 50 mg p.o. t.i.d. to q.i.d.) for several days.