Eczema On The Face, Eyelids and Around The Eyes 

What is eczema on the face and around the eyes?

Eczema that appears on the face and around the eyelids is an inflammatory skin condition causing patches of dry, irritated, and highly sensitive skin. When this condition develops specifically around the eyes, clinicians refer to it as periocular or periorbital dermatitis. It can affect the eyelid, the under-eye area, and the surrounding brow bone.

The key signs and symptoms to look for

The primary symptoms of facial and eyelid eczema include:

• Persistent, intense itching
• Redness or noticeable discolouration of the skin
• Dry, flaky, or scaly patches
• Swelling and puffiness of the eyelids
• Weeping or crusting if the skin barrier breaks down

Many people report that the itch associated with facial eczema is particularly severe. It can often feel like a burning or deep gnawing sensation, making it very difficult to avoid scratching.

How facial eczema can look on different skin tones

Eczema symptoms look different depending on your natural skin tone.

On lighter skin tones, active facial eczema typically appears as distinct areas of redness, pinkness, or a general flushed appearance across the cheeks and eyes.

On brown and black skin, eczema rarely looks red. Instead, it can appear as darker brown, purple, or ashen grey patches. Following a flare-up, the inflammation can also lead to temporary changes in skin pigment, leaving behind patches of lighter skin (hypopigmentation) or darker skin (hyperpigmentation).

People with a history of atopic eczema may also notice a Dennie-Morgan fold. This is an extra, visible fold or line of skin that develops just under the lower eyelid. It is a common characteristic of atopic skin and is entirely harmless.

The main causes and types of facial eczema

The main causes of facial and eyelid eczema involve a weakened skin barrier reacting to environmental triggers, allergens, or irritants, though the exact underlying cause depends on the type of eczema you have.

Understanding the different types of eczema

There are three main types of eczema that commonly affect the face.

Atopic eczema: This is the most common type. It is closely linked to genetics and an overactive immune system. In atopic eczema, the outer skin barrier is naturally weaker and less able to retain moisture. This makes the delicate facial skin highly prone to dryness and extremely reactive to everyday triggers.

Contact dermatitis: This occurs when the skin reacts to a specific substance. It breaks down into two sub-types:

• Irritant contact dermatitis: This is caused by direct contact with harsh substances that strip or damage the skin barrier. Common culprits include strong soaps, facial scrubs, and astringent makeup wipes.
• Allergic contact dermatitis: This is an immune system reaction to a specific allergen. For the eye area, common allergens include nickel in eyelash curlers or tweezers, fragrance in eye creams, preservatives in contact lens solutions or eye drops, and even nail varnish that is accidentally transferred to the eyelid when you touch your face.

Seborrhoeic dermatitis: This type is caused by an overgrowth of a normal yeast that lives on the skin. It typically causes greasy, yellowish scales and redness. On the face, it most commonly affects the eyebrows, the sides of the nose, and the hairline, though it can extend towards the eyes.

Common triggers for flare-ups around the eyes

Eczema flare-ups are often set off by a combination of factors. Common triggers that affect the delicate eye area include:

• Allergens: Pollen, dust mites, and pet dander can settle directly onto the face and eyelids.
• Irritants: Mascara, liquid eyeliner, foaming cleansers, heavy anti-ageing eye creams, chemical sunscreens, and chlorine from swimming pools. Sweat is also a very common irritant for facial eczema.
• Environmental factors: Cold winter winds, dry air from indoor central heating, and washing the face with very hot water.
• Behavioural factors: Rubbing the eyes excessively can physically damage the thin skin, while periods of high stress can trigger the immune system to produce an inflammatory response.

Treating eyelid and facial eczema

Treating facial and eyelid eczema focuses on restoring the skin barrier with regular emollients and reducing active inflammation with carefully selected prescribed medications.

The foundation of care: emollients and moisturisers

Emollients are medical moisturisers. They are the most important part of any eczema treatment plan. Emollients work by forming a protective layer over the skin surface to trap moisture inside and block external irritants from getting in. Cochrane Skin guidelines list emollients as a primary topical treatment for inflammatory skin conditions.

For the face and eyelids, you need to apply a thick, fragrance-free emollient cream or ointment at least two to three times a day. When applying it around the eye area, always use a clean finger to gently dab the product onto the skin. You must never rub it in vigorously.

Medical treatments a doctor may prescribe

If emollients are not enough to control a flare-up, a GP may prescribe medicated treatments to reduce the inflammation.

Topical corticosteroids (steroid creams): Doctors sometimes prescribe a very short course of a mild topical steroid to manage a sudden flare-up. NHS local guidance confirms that periocular eczema can be managed with regular emollients, gentle eyelid hygiene, and a short course of mild topical steroids prescribed by a clinician.

However, you must exercise extreme caution. Only the mildest steroids should be used on the face. NICE guidance for primary care states that steroid potency must always match the site, with weaker corticosteroids used on the face. Furthermore, NICE clinical guidance warns that facial skin absorbs topical corticosteroids more readily, and long-term use on the eyelids may be associated with an increased risk of glaucoma.

Oral antihistamines: If the itching is severe and disrupting your sleep, a GP might suggest a short course of a sedating antihistamine to take at night.

Common mistakes to avoid when treating facial eczema

When managing eczema around the delicate eye area, you should avoid the following common mistakes:

• Do not use a steroid cream prescribed for someone else, or one prescribed for a different part of your body. Official NHS advice on beclometasone skin creams and betamethasone for skin states clearly that you must not use these stronger medications on your face, near your eyes, or on your eyelids unless a doctor has explicitly told you to.
• Do not apply very hot or very cold compresses. Cool compresses are best for soothing an itch.
• Do not stop using your daily emollients as soon as your skin feels better. Eczema requires continuous barrier protection.
• Do not rub or scratch your eyes. This worsens inflammation and can easily introduce a bacterial infection.

When to see a doctor about facial eczema

You should book an appointment with a GP to discuss your facial eczema if:

• Your eczema is not improving with a strict emollient routine or is getting worse.
• You notice weeping skin, yellow crusts, or small fluid-filled blisters, as these are signs of a bacterial or viral infection.
• Your vision is affected in any way.
• The eczema is causing significant emotional distress or preventing you from sleeping.

Skincare routine for sensitive eyes

A careful, consistent daily skincare routine prevents irritants from triggering an eczema flare-up around your eyes by keeping the skin barrier clean and hydrated.

Step 1: How to gently cleanse your face and eyes

Cleansing removes daily dirt and allergens, but it must be done without stripping the skin's natural oils. Use a gentle, soap-free, unperfumed cream or gel cleanser.

1. Wash your hands thoroughly with soap and water.
2. Ensure the tap water is lukewarm. Hot water strips moisture and worsens itching.
3. Gently massage the cleanser onto your face, avoiding the immediate eyelid area initially.
4. Rinse thoroughly by splashing water onto your face.
5. Gently pat your skin dry with a soft, clean towel. Do not rub the towel across your face.

Step 2: How to safely apply creams and treatments

The skin around the eyes requires a specific, gentle application technique.

1. Use the "rice grain" or "eyelid dot" method. Squeeze a tiny amount of your emollient or prescribed treatment (roughly the size of a grain of rice) onto your fingertip.
2. Dab tiny dots of the cream around the orbital bone, which is the hard bone you can feel around your eye socket.
3. Use your ring finger to very gently tap and blend the cream in. The ring finger naturally applies the least pressure. Move from the outer corner of the eye inwards, being very careful not to pull or stretch the skin.

Step 3: Choosing and applying makeup safely

You can wear makeup if you have eczema, provided you choose products carefully and remove them gently.

Always opt for hypoallergenic, fragrance-free products. Mineral-based makeup powders are often better tolerated by atopic skin than heavy liquid foundations. Before applying any new cosmetic product to your face, patch test it on a small area of sensitive skin, such as behind your ear, and leave it for 48 hours to check for a reaction.

If eyeliner irritates your lash line, swap hard eyeliner pencils for softer, smudgeable crayon types that require less pressure. You should also avoid waterproof mascara, as this requires harsh, alcohol-based removers to take off.

Step 4: How to remove eye makeup without irritation

Removing makeup is a common trigger for periocular dermatitis. Avoid makeup wipes entirely.

1. Apply an emollient or a fragrance-free, oil-based makeup remover to a soft cotton pad.
2. Hold the damp pad gently over your closed eye for 10 to 15 seconds. This gives the product time to dissolve the makeup.
3. Gently wipe downwards in one single direction. Do not scrub the pad back and forth across your eyelid.
4. Cleanse your face as normal afterwards to remove any lingering makeup residue or oily remover.

Is it eyelid eczema, blepharitis, or conjunctivitis?

Eyelid eczema, blepharitis, and conjunctivitis are distinct inflammatory conditions that cause red, itchy eyes, each requiring very different approaches to treatment.

Special considerations for facial eczema

Special considerations for managing facial eczema are necessary for certain groups, such as contact lens wearers and young children, to prevent complications and ensure comfort.

Advice for contact lens wearers

Wearing contact lenses can be challenging when you are managing an eczema flare-up on your eyelids. The physical act of inserting and removing lenses can irritate the skin, and lens cleaning solutions sometimes contain preservatives that trigger contact dermatitis.

To minimise irritation, consider switching to daily disposable lenses. Dailies avoid the buildup of allergens on the lens and remove the need for harsh cleaning solutions. Always put your contact lenses in before applying any makeup or creams, and take them out before you begin your makeup removal routine.

During a severe eczema flare-up, the safest option is to switch to wearing glasses for a few days to give your eyes a complete rest from physical handling.

Managing facial eczema in babies and children

Atopic eczema is very common in babies and young children, frequently appearing on the cheeks, chin, and around the eyes.

In young children, key triggers often include excess drool from teething, acidic food left around the mouth, and the preservatives found in certain baby wipes. It is crucial to keep their fingernails short and filed smooth to minimise the damage caused by night time scratching, which can quickly lead to an infection.

Parents are often worried about using medicated creams on young skin. Our online GPs regularly speak to parents about this exact concern and can help provide a safe management plan. NHS guidance for parents is clear that you should avoid using anything other than very mild steroids near the eye or on the eyelids of a child. Frequently asked questions