Physicians in various specialties—and dermatologists in particular—frequently encounter various forms of inflammation of the eyelids and of the anterior surface of the eye. Distinguishing the cause of itchy, painful, red, edematous eyelids is often difficult. Because the uppermost layer of the eyelids is part of the skin that wraps the entire body, almost every skin disease in the textbook can affect the periorbital area as well. In this contribution, we focused on the most common such disorders that require special consideration, as a result of their special appearance, their challenging diagnosis, or the nature of their treatment. We reviewed the key features of several common dermatides that affect the eyelids, such as atopic dermatitis, seborrheic dermatitis, allergic contact dermatitis, airborne contact dermatitis, rosacea, psoriasis, and others. We focused on the special clinical features, causes, and treatments specific to the delicate skin of the eyelids. Because structures of the eye itself (ie, the conjunctiva, the cornea, the lens, and the retina) may be involved in some of the discussed periorbital skin diseases, we found it useful to add a brief summary of the eyelid complications of those diseases. We then briefly reviewed some acute sight-threatening and even life-threatening infections of the eyelids, although dermatologists are not likely to be the primary care physicians responsible for treating them.
Cicero (106-43 bce) is credited with saying "The eyes are the mirror of the soul," and many others, including Shakespeare and Leonardo da Vinci, have echoed those sentiments. For dermatologists, the eyes—or, more specifically, the eyelids—are a transition area between the thinnest skin of the body and the conjunctiva that actually covers the eye. We consider the eyelids to be the most vulnerable and sensitive areas of the body as well as the areas with the greatest environmental and cosmetic exposure. Because the uppermost layer of the eyelids are part of the skin that wraps our entire body, almost every skin disease in the textbook can affect the periorbital area as well. In this contribution, we will focus on the most common such disorders that require special consideration, as a result of their special appearance, their challenging diagnosis, or the nature of their treatment. We will also mention some less common disorders to raise the level of awareness that surrounds them because of their potential risk of serious sequelae to the patient.
The range of differential diagnoses of eyelid dermatides is extensive, including as it does such conditions as eyelid inflammation, erythema, edema, weeping, and scaling, which are often accompanied by burning or itching. Distinguishing the cause of pruritic and inflamed periorbital skin may be challenging, and choosing the appropriate therapy will be as well. We will review the key features of several common dermatoses in the hope of assisting physicians with diagnosing and treating these conditions.