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

Critical

Periorbital edema, erythema, vesicles, and lichenification of the skin. Conjunctival chemosis out of proportion to injection and papillary response (see Figure 5.12.1).

Figure 5.12.1: Contact dermatitis.

Other

Watery discharge; crusting of the skin may develop.

• Varicella zoster virus (shingles): Dermatomal pattern with severe pain. See 4.17, Herpes  Zoster Ophthalmicus/Varicella Zoster Virus.

• Eczema: Recurrent in nature and is markedly pruritic.

• Impetigo: Pruritic with honey-colored crusts.

• Orbital cellulitis or preseptal cellulitis: See 7.3.1, Orbital Cellulitis and 6.9, Preseptal Cellulitis.

Most commonly eye drops and cosmetics.

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.

Re-examine within 1 week.