Contact dermatitis

Anatomically, the eyelid can be divided microscopically into (1) skin, which is made up of epidermis and dermis; (2) submucosa (3) muscular layer; (4) submuscular layer (dense connective tissue); (5) fibrous layer; and (6) palpebral conjunctiva. The thin nature of the eyelid makes it susceptible to inflammation resulting from allergy. Minimum levels of irritants contacting the adnexal area can penetrate the skin to initiate the allergic cascade. Allergic reactions that involve the eye may begin via contact to the skin, but often involve the conjunctiva. Eczema is the general term that describes the superficial inflammatory process involving the epidermis. Contact eczema is characterized by varying elements of epidermal erythema, papules, and vesicles. Allergic dermatoconjunctivitis connotes involvement of both the skin and conjunctiva.

A 24-year-old man came to the clinic with a red, swollen left eye. Based on the history, the constellation of signs and symptoms (lack of diffuse or focal pain, presence of periorbital and conjunctival edema, absence of fever), and failed resolution after treatment with injectable antibiotics, the diagnosis of type IV delayed hypersensitivity reaction secondary to toxic/chemical exposure was made. Speedy resolution was accomplished using a sequenced therapy, which included oral antihistamines, topical cycloplegics, topical antibiotics, topical steroids, and palliative therapies.

Optometrists should be familiar with the signs and symptoms of contact eczema and allergic dermatoconjunctivitis. Treatment includes management of the skin and adnexae, as well as the ocular manifestations.