Sho Katayama, Mitsuhito Ota
A 62-year-old man who required hemodialysis thrice weekly developed an asymptomatic eyelid rash. Two days before presentation he had undergone computed tomography with iodinated contrast. Scheduled hemodialysis was performed 22 hours later. Examination disclosed several firm eyelid nodules, some of which were hemorrhagic (Fig A), and swelling around the meibomian gland orifices (Fig B). Biopsy evinced a dense dermal infiltrate of neutrophils and histiocytes (Fig C). Iododerma, a hypersensitivity reaction to iodine, was diagnosed; impaired renal clearance of iodine is a known risk factor. The patient died of an unrelated disease a few days later. (Magnified version of Fig A- C is available online at www.aaojournal.org).
Chisholm, Smith Ann M.; Couch, Steven M.; Custer, Philip L.
Purpose: Allergic dermatitis is a common but often misdiagnosed condition that can present with a variety of findings including inflammation, eyelid malposition, and tearing. This study was performed to identify likely etiologies, along with presenting findings and treatment strategies for allergic dermatitis.
Methods: A retrospective review of clinical records was performed of patients diagnosed with allergic dermatitis in academic oculoplastics practices from 2002 to 2014. Initial consultation included review of medications and cosmeceuticals. Suspected allergens were discontinued and an ophthalmic steroid was applied. Persistent allergic dermatitis led to further medication changes or formal allergy testing in an effort to identify the causative agent.
Results: Sixty-one patients were identified; average age was 66 years old (range: 33–94), and 45 of the patients were women (74%). Average follow up was 7 months (range: 1–60 months). Reasons for referral included epiphora (31.2%), ectropion (24.6%), blepharitis/dermatitis (18.0%), and “droopy” eyelid (14.8%). Presenting symptoms included irritation (77.1%) and tearing (50.8%). Average duration of symptoms was 16.5 months (range: 2 days–8 years). The 3 most common etiologies were eye drops (54.2%), creams/lotions (24.6%), and cosmetics (13.1%). Rubbing/manipulation was also thought to be a significant factor in 30% of the patients. Overall, the initial treatment regimen led to at least partial resolution in 88% of patients and 66% experienced complete resolution. Patients resistant to therapy were referred for patch testing. At follow up, 98% of patients had improvement in their symptoms and 90% of patients had complete resolution of their symptoms.
Conclusions: Allergic eyelid dermatitis is commonly related to eye drops and topical cosmetics or skin care products. Identification and elimination of causative agents is the mainstay of management. Topical corticosteroids often facilitate resolution of the associated inflammation. Therapy resistant patients may benefit from formal allergy testing.