Contact Dermatitis on Eyelid

June 21, 2013

Contact dermatitis to paste-on fingernail decorations developed when the patient held her lower eyelid down with her index finger to insert her contact lenses.

A 20-year-old woman complained about the acute onset of itching and swelling of the right eye. She did not use eye cosmetics (such as mascara and eye shadow).

Key points: Physical examination disclosed a swollen and erythematous lower right eyelid and some macular erythema of the right infraorbital skin. Contact dermatitis was suspected and further history disclosed “paste on” decorations only on the right fingernails. The patient acknowledged that she held her lower lids down with the ipsilateral index finger while putting in contact lenses with the contralateral index finger.

Treatment: The pruritic eruption resolved following a week of daily application of desoximetasone ointment. Following removal of the nail decoration, there was no recurrence.

Note: The key to this case is the asymmetric and unilateral placement of the eyelid contact dermatitis, which is almost always due to a reaction to an agent transferred from the hands. Common causative agents include nail polish, “gel” and “solar” artificial nails, applied nail decorations, lanolin-containing hand moisturizers, and hand soaps (because of fragrance and preservative).