What's up, which doc?

January 25, 2006 4:01 PM

My eyelids itch. Really badly. All the time. The family doctor said it might be eczema, but I'm not sure. Should I go back to her, see a dermatologist, or see an eye doctor?

I asked my regular family doctor about the itchy lids about six months ago, when it first started, and she diagnosed eczema. Since then, whatever it is has spread to beside and underneath my eyes as well. I look like someone has just walloped me most of the time. It's itchier, too.

I've had eczema before, usually on my arms and hands, so I can believe that eczema is a real possibility, though I wouldn't stake my life on it. (Probably just in denial.) The family doc prescribed Elidel. But the Elidel won't stay on my eyelids -- it just runs down into my eyes, which is quite painful and makes me rub 'em, the opposite of its intended effect. And then I've got red eyes to match the red around my eyes.

Thing is, my doctor said if the Elidel didn't work, we'd have to try steroids. (Not a steroid cream either, because apparently that could eat right through my eyelids.) I've heard lots of negative comments from past users of steroids in this situation, and I really don't want to go that route unless it's the only solution.

To give you a little more background, I haven't worn eye makeup in over 6 months, since this started. I know that the eczema flare-ups I had on my arms and hands were related to stress and/or allergies. I'm not having any other allergic symptoms. Although I am in a weird situation at work, I don't think I'm that stressed about it.

I know I need to go to a medical professional about this, but I can't figure out what kind of doctor to go see. I could go back to my family doctor, but it doesn't sound like she has any ideas besides the steroids. Luckily my health insurance doesn't require a referral to see a specialist, so I could also go directly to a dermatologist. Or should I go to an eye doctor, since this is, you know, right there at my eyeballs and I had LASIK less than 6 months ago? (Would that even matter?)

Also, any advice you have about stopping the itching will be gratefully accepted, because even if I call a doctor and get an appointment tomorrow, I've still got to make it until then without clawing my eyes out!

posted by Jaie to health (19 comments total)

Oh, and if I see a dermatologist, is he gonna hate me if I say "By the way, I think I've got a plantars wart on my foot. Can you look at that too?"
posted by Jaie at 4:02 PM on January 25, 2006

My eyelids itch a lot too. I blame it on a combination of stress at work and lack of sleep, because it stops when I take a break for a few days. Another thing I have considered is allergies; I work with a number of potential allergens so it would surprise me if I became allergic to this place.

Anyway, I don't really have an answer, but have you had the opportunity to take a long weekend or something whilst this has been going on? This could give clues as to whether it's related to the work situation (in which case head doctor?)
posted by nowonmai at 4:25 PM on January 25, 2006

Dermatologist is definitely the best bet, and they should have no problem looking at your feet too.
posted by karmaville at 4:32 PM on January 25, 2006

Go to an eye doctor. You had LASIK, which is a factor. As well, if it really is a case for a dermatologist, the eye doctor may have a good referral for someone who's had similar problems.
posted by Saydur at 4:34 PM on January 25, 2006

My sister and brother both have excema on their eyes. For both of them, it helps to take allergy meds (benadryl, etc), AND wash the skin around their eyes very gently with Cetaphil several times a day. My sister also realized that she can't wear mascara or eyeshadow or concealer-- no make-up on the eyes at all. They both went from looking like pink scabby raccoons to looking normal after 10 days or so of the washing regimen. Good luck!
posted by bonheur at 4:44 PM on January 25, 2006

I have chronic ezcema on my eyes.

I use Elidel occasionally, but I've been prescribed the steroid cream Elocon, which they suggest I use sparingly, since it can cause thinning of the eyelids. It usually offers instant relief (and a brief bout of burning) from any itchiness or pain.

I would suggest you speak to a dermatologist. Eyes + ezcema = not something just a GP should be looking into, especially if it bothers you that badly.

I also get it in both the inside and outside corners of the eys, where it will hurt like hell whenever I blink.

Good times.

Ask about Elocon. I've been using it since I was six, once or twice a month. And I still can't see through my eyelids...
posted by disillusioned at 4:44 PM on January 25, 2006

IANAD, but has your derm mentioned Protopic? Like Elidel, it's non-steroid. I think they both came out about the same time. I've been pretty happy w/ it.

I *think* it's safe for use on the face (I'm pretty sure my derm said it's ok for that). It's an ointment, as opposed to Elidel, so maybe it would stay put a little better. Although you probably wouldn't want to use it outside of the house -- it makes your face all shiny-like.
posted by awegz at 4:50 PM on January 25, 2006

Go to the GP and ask him/her for a referral to a dermatologist. When you call to set up the appointment, the receptionist should ask what you're seeing him for; you tell her, briefly, that you have what may be eczema around your eyes and you also have a plantar wart.

If you wait until the doctor's in the room before you go "Oh yeah, and I have a wart too," he probably won't be happy, and the schedule may be thrown off. Saying it in advance isn't strictly necessary, but gives them the option of scheduling you for a longer time.
posted by booksandlibretti at 4:51 PM on January 25, 2006

But yeah, be careful with the steroid creams. I have patches on my arms and legs that looks very splotchy and pale if I get any sort of color in the summer (and I'm not laying out baking or anything -- just a little color from being outside). I used steroid creams nightly when I was little.
posted by awegz at 4:55 PM on January 25, 2006

Go see an ophthalmologist.
posted by radioamy at 5:08 PM on January 25, 2006

Call your family doctor and ask them to find an opthalmologist with experience/specialization in dealing with dermatoligical aspects of opthalmology or for a dermatologist with experience/specialization in dealing with the skin around the eyes.

The doc probably won't be able to come up with someone off the top of their head, so you'll have to wait a few days while they do some research. But definitely get someone who will know about both aspects.
posted by duck at 5:36 PM on January 25, 2006

I've had eczema on my eyelids for almost my whole life. The breakthrough in treatment for me was to use ointment based 0.5% hydrocortisone (yes, a steroid, but a mild one... and see below). The ointment stays on so much better, moisturizes better, and is just all around more effective. The cream based 0.5% hcl was not effective and actually made the scaliness worse. Elidel was not effective and hurts like hell when it gets into the eye.

I believe the lower frequency with which one has to apply the weak ointment hcl more than offsets the fact it is a steroid and is implicated in skin thinning. I wouldn't use anything stronger than 0.5% hcl without talking to a doctorAnyway, the ointment is cheap and in my view definitely worth a try.
posted by Rumple at 6:37 PM on January 25, 2006

Years ago, my eye doctor doctor diagnosed me as having blepharitis, or inflamation of the eyelid. He recommended washing my eye area with baby shampoo, which the linked NIH site also discusses. I don't use baby shampoo any more, but I do make sure to "wash" my eyelashes when I wash my face and he hasn't mentioned it since.
posted by SashaPT at 7:06 PM on January 25, 2006

Another product for eczema that I have been very happy with is dermasmoothe which has a very light topical cortisone and is a very good moisturizer. It is safe enough to use on infants in place of Eledil which is prescribed very sparingly.

Dermasmoothe is an oil that needs to be applied to moist skin. Originally prescribed for the scalp but it works wonders elsewhere. I and my regular doctor never heard of it until my dermatologist recommended it.

There is a variant of the product called Moisture Rise which is just the moisturizer component without the topical.
posted by jadepearl at 7:30 PM on January 25, 2006

Rumple—are you saying that hydrocortisone creams don't also hurt like an unholy bitch when they get in your eye?

Elocon in the eye is an experience unlike any other I can think of.

The only exception, of course, being bleeding/oozing ezcema on 60% of my body a few years ago. Sticking to your bedsheets: Not fun.

Suffice to say, be careful putting these things on your eyelids, but know that you won't go blind outright from it.
posted by disillusioned at 7:42 PM on January 25, 2006

Another opinion, if you can stand it:

First, you need a dermatologist, NOT an Ophtho, for reasons that aren't worth going into.

Atopic dermatitis/eczema can occur exclusively around the eyes ('periorbital'), but it's a bit odd. The localization and intense itching strongly points to an allergic reaction. In general, it's tough to find the trigger, fwiw, but numerous ingredients in make-up, soaps, etc, can do this.

Elocon and dermasmooth oil are both extremely strong steroid preparations and, imo, should never be used on the eyelids, which are quite sensitive and fragile tissues (see also genitals).

Thing is, my doctor said if the Elidel didn't work, we'd have to try steroids. (Not a steroid cream either, because apparently that could eat right through my eyelids.)

This is odd. Are you saying your doctor will use oral steroids? If so, I would diplomatically submit that you are on the receiving end of bad advice.

I second calling your FP and requesting a referral, and remember a few things - your doctor ought to want to send you to the best Derm they know of, and second, most specialists won't let you make an appointment without a referral these days, despite what your insurance says. Ironically, all the carping about Primary Care acting as 'Gatekeepers' morphed into specialists getting accustomed to the PCP screening out crap self-referrals.

And definitely tell them up front about the wart. But, keep in mind if the doctor is rushed, you're going to get less of an introspective analysis of your original problem if they know they also have to treat your wart.
posted by docpops at 7:53 PM on January 25, 2006

I have had the exact same thing recently. I am pretty sure mine is allergies - anyway.

First I went to the allergist - he gave me some eye drops and said if that doesn't work go to an opthomologist. It didn't work.

Optho - Gave me TobraDex - went on it for 10 days or so 2x/day - cleared it up but when I stopped it came back, so she said she was fine with me applying once daily before bedtime.

I have been doing this since and all is well. I have flair ups sometimes, mostly if I forget my daily treatment.

Package says that tobradex contains 0.3% tobramycin and 0.1% dexamethasone. From what the doc said its a combo steriod and antibiotic.
posted by jopreacher at 10:26 PM on January 25, 2006

Good lord. I doubt I have anything helpful to add, but I just wanted to say that I'm really, really sorry you have to go through this and that I totally sympathize. I've tried nearly every medication listed here (Tobradex, Elidel, topical and oral steroids, and a bajillion others) for my allergies. My eyes and eyelids and face itch like crazy and get really swollen and I haven't found anything to help. I feel your pain.
posted by booknerd at 11:32 PM on January 25, 2006

I too am sorry for your pain, but so relieved that I'm not the only one out there with eye eczema!

I was sent to a dermatologist by my primary care, and was prescribed Protopic, which works quite well on my eyes (and everywhere else) but also involves that dripping, burning, makes the situation much worse response. When I have to use it, I use it super-sparingly and only at night. That said, I've been trying to find other treatments. I've tried "dermarest" which is a very nice 1% hydrocortisone lotion, but I worry about someday thinning out my eyelids with it...

Other than that, I wash 2x or more with Cetaphil and have been trying to train myself not to touch my eyes. (Difficult) I was told that it was allergic eczema, but the derm was unhelpful in tracking down the cause. He did a patch test, but nothing was found that was definitively the culprit. Since I don't wear make-up, I figure it's something I touch with my hands and then transfer to my eyelids. I try not to touch them, and wash my hands as much as I can in case I do. I would say not touching them has helped, but not completely. The other reason for not touching them is to keep from irritating the situation. Eczema is easily aggravated as you know, and itching really does make it worse. It is also heat sensitive, and though a nice hot shower feels great, cooler would be better.

Along those lines, cold is your friend when the itching is unbearable. I have a gel eye-mask I keep in the fridge, or put in the freeze for a minute depending on how bad the itching is, and sitting with this on my eyes is such a great relief. It brings down the swelling too. A cold cloth would work just as well.

I'm sorry if you already new all this, but I wanted to at least pass this info along. Good luck.
posted by sarahmelah at 5:00 AM on January 26, 2006