Eyelid dermatitis: Work-up and future diagnostic innovative solutions

Eyelid dermatitis (ED) is an interdisciplinary medical challenge affecting thousands of patients worldwide. ED management can be difficult in view of the numerous differential diagnoses and limited treatment options. We review the diagnostic work-up for ED patients, with a special focus on the latest innovative solutions.

The diagnostic work-up of ED should include medical history, exposure analysis (direct contact, transfer by hands, airborne exposure, rarely ingestion) ocular complaints, clinical severity scores for eyelid manifestations, and consider general and specialized scoring systems. Patch testing and Schirmer test modifications can be used to delineate the underlying aetiology and to narrow the ED differential diagnosis. Metal release assays (nickel spot test, cobalt spot test) as well as gold jewelry avoidance can inform on clinically relevant metal allergy in selected cases. Repeated open application tests with cosmetic products can be used on the retroauricular skin. Transepidermal water loss (TEWL) measurements should be adapted for the eyelids. Further research on eyelid microbiome and transcriptomic biomarkers in the tear fluid and/or eyelid keratinocytes is required. Atopy patch testing with house dust mites (HDMs) can be helpful in selected cases but needs further standardization. Machine learning algorithms may aid image analysis for automated patch test readings and may leverage transcriptomic data for diagnostic classifications, particularly in ambiguous cases, and treatment monitoring in ED.

ED diagnosis can be challenging and may require the collaboration of ophthalmologists, dermatologists, allergists, and rheumatologists. Diagnostic innovations exist but their value in the diagnostic work-up is currently unclear.