A 70-year-old woman was seen on an emergency basis because of the acute onset of an intensely pruritic eruption on the face. She had a history of eczema.
Key point: The predominance of infraorbital erythema and swelling suggests that her condition is related to a material being placed in the eyes and then dripping down from them. In fact, the patient had been instilling drops, on a near daily basis, for several months to relieve symptomatic dry eye. Patch testing proved her to be allergic to benzalkonium chloride, the preservative contained in the ocular solution she had been using.
Treatment: The offending medication was stopped, and another eye drop containing a different preservative was substituted. The patient also applied topical desonide 0.05% cream to the affected area to provide immediate symptomatic relief.
Note: Allergic contact dermatitis that affects the eyes — due to cosmetic nail products—is predominantly located on the upper lid, and not below the eye.