Dr Margaret answers emailers’ embarrassing problems
in this monthly problem page.

Scaly eyelids

Dear Dr Margaret

Why are my eyelids scaly and itchy? This has been happening for the past few months.

The most likely reason is that you are reacting to some chemical substance. This is the case in 75% of people with scaly eyelids. The skin of the eyelids is particularly sensitive to chemicals, so around the eyes may be the only place where you have a reaction.

Working out the cause

Nail varnish is one of the most common causes. After painting your nails, the varnish will give off tiny amounts of chemical vapour for a while, even when it feels dry. If you rub your eye, the eyelid skin may react. Artificial nails can cause a similar eyelid reaction. The skin around the nail is usually unaffected, because it is tougher than eyelid skin.

Have you started using different skin-care preparations, make-up or hair products within the past few months? If so, one of these might be the culprit. Have you recently started curling your eyelashes? Eyelash curlers made from nickel are a possible cause.

If the problem is severe, the only way to deal with it is to stop using all cosmetics and skin-care products until it settles down. Try to stop scratching and rubbing your eyes. Your doctor could give you some steroid cream to help reduce the inflammation. Then you should restart using your skin care products and cosmetics, one at a time every few days. By this method, you should be able to identify any that cause a reaction. If this does not work, your doctor may be able to arrange ‘patch testing’ to find out what chemicals your skin reacts to.

If you have eczema

If you suffer from eczema, you may not be able to pin the blame on one particular irritant, because your skin will be extrasensitive to many substances. Therefore you just have to be very careful about all cosmetics and cleansers. Choose ‘hypoallergic’ and non-perfumed ranges whenever possible. Your doctor will be able to provide a suitable steroid cream for flare-ups.

It might be ‘blepharitis’

If the scaling and itching particularly affect the edge of the eyelids between the lashes, and your eyes are sticky and crusted when you wake, you probably have a condition called ‘blepharitis’. This can be caused by a dandruff-like condition, or because the oil glands in the eyelid are not functioning properly. Sometimes there is also a low-grade infection. There is no absolute cure, but your doctor may prescribe a short course of eye antibiotic.

To clean your eyelids, dip a cotton wool bud in baby shampoo and water (half water, half shampoo), shut your eyes, wipe along the margins with the cotton wool bud and rinse off with clean water.

‘Warm soaks’ twice a day can help soften the crusts. To do this, wash your hands thoroughly, then soak a clean flannel in warm water. Close your eyes and place the flannel on your eyelids for 5 –10 minutes. Rewarm the flannel in water if it cools. If your eyes are dry, ‘artificial tears’ solution from a pharmacy will help.

Sources of information

De Vries H. Blepharitis. In: Eekhof JA, Hopcroft K, Neven AK, Verheij TJM, eds. Minor ailments in primary care – an evidence-based approach. Elsevier: Amsterdam, 2005.

Graves JE, Brodell RT. Erythematous scaling eyelids: patient history, exposure to allergens and irritants are keys to diagnosis. Postgraduate Medicine 2005;117:43 –5.

Guin JD. Eyelid dermatitis: a report of 215 patients. Contact Dermatitis 2004;50:87 –90.

Guin JD. Eyelid dermatitis: experience in 203 cases. Journal of the American Academy of Dermatology2002;47:755 –65.

Ruckert L, Fraser S. External eye problems presenting to GPs. Pulse 2002;Oct 28:50 –2.