Contact Dermatitis

Fig 1: Contact dermatitis caused by environmental etiology

Though fairly rare, contact lens related periorbital contact dermatitis is often a perplexing condition to differentially diagnose. An example of delayed hypersensitivity, contact dermatitis takes time to manifest, further complicating the diagnosis (figure 1). Patients often present complaining of red, scaly, and itchy eyelids. Because of the delayed nature the patient is often unable to identify a precipitating factor. Non-contact lens related causes include cosmetics, soaps, and other skin care products. In contact lens associated contact dermatitis the likely offending agent is the solution preservative, with thimerosal most often implicated. Regardless of the precipitating agent, the clinical presentation is often exacerbated by an associated dry skin (figure 2).

Management of contact dermatitis involves discontinuation of lens wear and therapeutic intervention. The condition usually responds promptly to topical ophthalmic steroid ointments, such as hydrocortisone or dexamethasone. Clinicians should be cautious in recommending these agents indiscriminately. Patients should be instructed to apply the ointment along the orbital rim, thus avoiding excessive migration into the tear film which in turn can result in an increased IOP. Patients should also be forewarned that prolonged, excessive use can lead to periorbital dermal thinning. This is particularly important as recurrence is likely until the offending agent has been identified and eliminated. Generally, contact dermatitis will respond within a one to two week period.

Fig 2: Eyelid contact dermatitis with cosmetic etiology

Contact lens management of contact dermatitis is fairly straight forward. The patient's contact lenses are discarded, and the solutions and storage cases are replaced with a different preservative or, when possible, a non-preserved regimen. Attention should be given to lens care adjuncts, such as the soap used prior to handling contact lenses. Each potential cause is sequentially eliminated until the culprit is identified.