Eyelid eczema (palpebral eczema) is an allergic skin disease that manifests in three forms: acute, subacute, and chronic. It can occur solely on the eyelids or be part of systemic or facial eczema.

bubble_chart Etiology

1. Irritant drug reactions: Local application of sensitizing substances. Such as ophthalmic medications like penicillin, sulfonamides, atropine, iodine, mercury, pilocarpine, etc., or prolonged use of cosmetics, metal eyeglass frames (so-called eyeglass eczema), and others.
2. Intraocular drug-induced reactions: Can be caused by sleeping pills, sedatives, sulfonamides, antibiotics, quinine, iodine preparations, and sodium para-aminosalicylate. Additionally, some individuals may develop eyelid eczema from consuming certain animal or plant proteins, such as fish, shrimp, meat, milk, eggs, and shelled plants like legumes.
3. Due to chronic conjunctivitis, ectropion, or dacryocystitis, where secretions or tears frequently irritate the eyelid skin.
4. Children with adenoid constitution and malnutrition are prone to this condition, often accompanied by phlyctenular keratoconjunctivitis.
5. Traditional Chinese medicine attributes it to wind-dampness pathogenic heat affecting the eyelid, or prolonged illness depleting blood, leading to wind and dryness.

bubble_chart Clinical Manifestations

Generally, it exhibits a certain degree of regularity.

1. Subjective symptoms: Appear after contact with allergens, with a sensation of heat and intense itching at the affected site.
2. Manifestations: Initially, the eyelid skin becomes red and swollen, with numerous blood rashes, blisters, erosions, and scabs locally. When secondary infection occurs, pustules may form. Healing occurs after scab shedding. The affected area can also expand to the face, forehead, etc. However, it can also transition from acute to subacute and chronic stages. The eyelid skin becomes rough and thickened, presenting a lichenoid appearance, with scales shedding from the surface, and possible pigmentation. If contact with allergens or medications continues, complications such as exudative conjunctivitis, superficial corneal infiltration, and edema may occur.

bubble_chart Diagnosis

1. Acute:
   1. There is obvious itching and burning sensation in the eyelid area.
   2. The eyelid skin is red and swollen, with erythema, papules, blisters (or pustules and ulcers if secondary infection occurs), and crusting.
   3. Increased blood eosinophils.
2. Chronic: Eczema persists for a long time without healing, the eyelid skin becomes rough and scaly, with tissue thickening.

bubble_chart Treatment Measures

1. First, immediately stop the use and contact with allergens and strengthen nutrition.
2. In the early stage, apply calamine lotion, 3% boric acid solution, saline, or wild chrysanthemum flower decoction for wet compresses. For nearly dry conditions, use zinc oxide ointment, tar oil, or hormone-based ointments. For long-term unhealed erosions, apply 1% silver nitrate solution externally.
3. Non-specific desensitization therapy: antihistamines, calcium preparations, etc. For systemic skin eczema, consider systemic hormone therapy and other symptomatic medications, or autologous blood injection.
4. Chinese medicine therapy: Take internally medicines that activate blood stasis, cool blood, clear heat, remove dampness, and detoxify. For acute eczema, use modified Shuangjie Decoction; for severe wind, add Notopterygium and Great Burdock Achene; for severe dampness, add Atractylodes Rhizome, Sophora, and Tribulus; for severe heat, add Gentian and Gardenia. For chronic cases, use modified Four Ingredients Decoction with Snakegourd Root, Scrophularia Root, Saposhnikovia Root, fineleaf nepeta spike, and Great Burdock Achene to dispel wind, nourish blood, and moisten dryness. Reference: Mix equal parts of blood scorpion, frankincense, myrrh, calomel, and litharge, grind finely, and apply with sesame oil to the affected area. Boil mulberry leaves with an appropriate amount of sodium sulfate for washing the affected area.