Red, Inflammed Eyelids: Advice From Dr. Herzog


A friend of mine recently sent me the following email asking for advice from Dr. Herzog:

Hi Jamie, I have a question for Dr. Herzog. The area around my eyes, particularly my eyelids, is red and scaly. It looks even worse when I put on makeup. I have had this happen almost every winter. What is going on and what should I do? Thanks so much!

Dr. Jo Herzog

Dear Friend,

There are several things that can make the area around the eyes red and scaly, but some causes are more common than others. Doctors begin the process of elimination beginning with most common causes and moving to less common ones until a diagnosis is made.

Contact dermatitis can make the area around the eyes, especially the eyelids, red and scaly. Contact dermatitis occurs when something that you are allergic to contacts this area. The contact can be direct (you wipe something directly on your eye) or airborne (you come into contact with an airborne allergen).

Many cases of contact dermatitis are caused by a reaction to the chemicals in nail polish, especially if one touches the eyelid with wet polish.  Touching the eyes while painting or using cleaning products or some makeup products can cause contact dermatitis. Eye drops and even hair spray might cause this in some patients.

Airborne causes of dermatitis occur if you are allergic to things in the environment. For example, if your neighbor is burning leaves with poison ivy in them, you might get airborne contact dermatitis when the air or smoke contacts your skin. This can be relieved by avoiding the allergen (stay away from burning leaves) and with mild topical steroids that your dermatologist can prescribe. In really mild cases,  OTC cortisone cream might help.

Atopic Dermatitis or “eczema” can also cause redness and scaling in the eye area. If this is the cause of your eyelid inflammation, you are more likely to have or have had this in other areas of the body or have a family history of eczema, allergies, asthma or hay fever.

This often is worse in extreme temperatures, winter being the most common time for exacerbation. Cold weather and the use of dry indoor heat probably contribute to this. Liberal use of moisturizers and topical steroids can help get this under control. I prefer thick, cream-based moisturizers such as cetaphil, cerave or vanicream. Again, mild cases might be treatable with OTC topical steroids, whereas the more severe cases need prescription medicines. A cool mist humidifier in the bedroom can help in winter.

So, why do you have red eyes in winter? If you are contacting something seasonal, it might be contact dermatitis.  Do you touch your eyelids with some allergen while decorating or gardening? Are you allergic to any plants that you are clipping or arranging? Do you or anyone in your family have eczema?  If you can figure out what is going on and can alleviate your symptoms with a few days of OTC medicine, then you are fine. If a few days of OTC medicine does not work and the problem persists, you should see your dermatologist.

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