This is a retrospective 12 year review of 61 patients diagnosed with periocular allergic dermatitis. The average age was 66 years, with 74% being female. The commonest indications for referral were epiphora, ectropion and blepharitis; and the main symptoms were irritation, itching and watery eyes. The mean duration of symptoms before referral was 16 months and on average patients had previously tried 2.5 topical lotions or drops, either prescription or over-the-counter. The clinical signs included conjunctival and lid inflammation and ectropion. The most common allergens were glaucoma drops, usually brimonidine (31%), other drops (23%), over the counter lotions (25%) and cosmetics (13%). Those with allergies to drops were more likely to have conjunctival injection than those allergic to skin preparations. Complete resolution was achieved initially in 65% by cessation of the suspected allergen and prescription of a steroid cream twice daily, and a further 23% had partial resolution. Eight patients with persistent disease were referred for patch testing which was positive in seven, four of whom were found to be allergic to gold. At final follow-up, 98.4% of patients had symptom reduction including 90% with complete resolution. Of the seven patients who underwent surgery for ectropion, which was deemed cicatricial at initial diagnosis, only one required a skin graft at the time of surgery. Another nine patients with ectropion had resolution without surgery. The article highlights that most patients with allergic dermatitis will respond to simple measures, and patch testing can be useful in identifying the allergen in the minority with recalcitrant disease.

Etiology and management of allergic eyelid dermatitis.
Chisholm SAM, Couch SM, Custer PL.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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