Eyelid dermatitis atopic H01.1

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 09.10.2021

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Synonym(s)

Atopic Blepharitis; atopic eyelid eczema.; Atopic eyelid eczema; blepharitis atopica; Lid eczema atopic

Definition
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Localized minus variant of a, topically limited atopic eczema. Atopic blepharitis may also occur as involvement of the eyelids in the context of extensive atopic dermatitis.

Clinical features
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Atopic eyelid dermatitis may present as acute, subacute or (frequently) as chronic dermatitic (eczematous) inflammation of the eyelids. The "eczematous situation" is essentially characterized by the special anatomical constitution (moist-fatty chamber constitution due to superimposed eyelid folds with reservoir character for toxic or allergenic substances) and the special functionality of the eyelid organ.

In the foreground of the clinical symptoms is an unpleasant, pemanent or intermittent itching. The itching leads to a constant, reflexive rubbing of the eyelids with fingers or the back of the hand. Recurrent conjunctivitis is often the result of mechanical irritation of the eyelids.

Atopic eyelid dermatitis may heal at any time; however, it may progress to eminently chronic, lichenified dermatitis. The consequences are redness, scaling, possibly crusting, permanent thickening of the eyelids and eyelid margins with breaking off and doubling of the eyelash rows(distichiasis: see figure).

This chronic inflammatory process is often associated with a change in the direction of growth of the eyelashes. Inward rotation of the lashes and eyelids leads to constant chafing of the conjunctiva and cornea with consecutive irritation syndrome of the eye(trichiasis). Not infrequently, ulcers of the cornea with subsequent scarring and loss of visual acuity are the result.

General therapy
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The primary goal is to heal the inflammatory skin changes. Contact toxins should be avoided if possible. A phase-appropriate topical therapy with glucocorticoid-containing topical preparations usually leads to a rapid improvement. If noxious substances cannot be avoided consistently, the course of the disease may be protracted and, in the case of prolonged treatment, glucocorticoid-saving therapy methods should be used to prevent atrophy induced by glucocorticoids, e.g. externals containing calcineurin inhibitors.

In parallel, the consistent application of a re-fattening and hydrating basic therapy is recommended to restore and maintain the barrier function.

In case of a "skin stressing" occupational history, the patients may have to be written off work in order to achieve healing.

Operative therapie
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Single inverted eyelashes can be epilated. In the case of multiple eyelashes, eradication of the pathological row of eyelashes is mandatory.

Note(s)
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For further clinical, pathogenetic and therapeutic details see below.:

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 09.10.2021