Causes and Risk Factors of Flaky Eyelids

In This Article

While you may assume that dry, rough, scaly patches of skin on your eyelids are simply a result of aging or climate, there are a number of common and uncommon causes of flaky eyelids to consider. A skin condition like eczema could be to blame, but so could a reaction to something you apply to the area or blepharitis, inflammation of the eyelids (among other possibilities). And chances are, if over-the-counter ointments and moisturizers fail to improve things, you may have a condition that needs specific treatment.

Woman rubbing eye
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Blepharitis

Blepharitis is a general term referring to the inflammation of the eyelids. It usually affects both eyelids, causing flaking and scaling nearer to the eyelashes. The eyelids themselves will appear greasy, while the lashes will often stick together or crust over while you sleep. Itchiness is common.

People with blepharitis often say that they feel grit beneath the eyelid and may experience eyelash loss due to constant rubbing and scratching. They may also have red, watery eyes and extreme sensitivity to light.

The cause of blepharitis is unknown but is believed to be caused by multiple factors including, among other things, bacterial or fungal infection, seborrheic dermatitis (dandruff), and clogged meibomian glands (which provide the eyelids with moisture).

If left untreated, blepharitis can lead to a sty (a boil-like lump on the edge of an eyelid), conjunctivitis (pink eye), or corneal ulcers.

A tissue swab can help determine if a bacterial or fungal infection is involved. Topical antibiotics or antifungals may be prescribed if an infection is identified. Steroid eyedrops or ointments may reduce inflammation, while Restasis (cyclosporine eye drops; available by prescription) may be recommended if your symptoms persist despite conservative therapy.

Atopic Dermatitis

Atopic dermatitis (eczema) is a condition characterized by the intermittent development of red, scaly skin. It can affect any part of the body, causing dryness, itching, tiny bumps, oozing, and reddish-brown patches (especially on the eyelids). Although it is uncommon for eczema to affect the eyelids only, it can occur.

Eczema symptoms can come and go, flaring periodically only to disappear for weeks, months, or even years at a time. Itching is often the most prominent symptom, which can cause inflammation and bleeding due to excessive scratching. Over time, the skin may begin to thicken and develop a cracked, scaly appearance.

It is believed that eczema is caused by a combination of environmental factors (which may help trigger the condition) and genetic mutations that predispose you to it.

Eczema can generally be diagnosed by sight alone. Treatment may involve moisturizing creams to hydrate the skin and antibiotic ointments to help fight infection. Topical steroids are generally avoided because they can cause irreversible skin thinning and ptosis (drooping eyelids).

If eczema symptoms are severe enough, your doctor may prescribe Protopic (tacrolimus) or Elidel (pimecrolimus), two topical immune suppressants that are safe on delicate skin like the eyelids.

Contact Dermatitis

Contact dermatitis is a red, itchy rash caused by direct contact with an allergen or irritant. The rash can develop over the course of minutes or hours and persist for two to three weeks. Along with redness and itchiness, there may be burning, tenderness, swelling, and the development of tiny, oozing blisters.

Like all allergic conditions, contact dermatitis is caused when an otherwise harmless substance is regarded as a threat by the immune system. The ensuing immune assault releases inflammatory chemicals at the contact site, causing tissues to swell and redden.

Contact dermatitis can be caused by any number of things that you apply to your eyelids or get into your eyes, such as:

  • Eye makeup and makeup applicators
  • Makeup remover
  • Face wash
  • Shampoo and conditioner
  • Moisturizers (particularly ones with fragrance)
  • Eyelash curlers (due to contact with metal and/or latex)
  • Tweezers
  • Eye drops
  • Sunscreen
  • Chlorine from swimming pools

If contact dermatitis is suspected, your doctor may recommend a patch skin test to check what, if anything, you may be allergic to. This involves the application of an adhesive patch to your skin which is infused with tiny amounts of different allergens.

In most cases, the avoidance of the suspected allergen is all that is needed to resolve contact dermatitis symptoms. In some cases, a mild 0.5% hydrocortisone cream may be used to treat an acute outbreak.

Less commonly, oral corticosteroid drugs may be used if the symptoms are severe or persistent (although they are generally reserved for when larger areas of skin are involved).

Uncommon Causes

There are several uncommon causes of flaky eyelids, some of which are closely linked to blepharitis. Key among these are rosacea and Demodex (a type of skin mite).

Rosacea

Rosacea is a common condition characterized by areas of skin redness and the development of tiny blood vessels (known as "spider veins" or telangiectasia) on the face.

Although rosacea most commonly affects the cheeks, forehead, and chin, it can also develop on the eyelids. If this occurs, it can lead to ocular rosacea in which the eyelids swell and the eyes become dry, red, and swollen.

The cause of rosacea is unknown, but it is believed to be the result of both environmental and hereditary factors. Light-skinned women are at greatest risk , as are those who smoke, have a family history of rosacea, or have sun-damaged skin.

There are no tests to diagnose rosacea. Doctors generally make this conclusion by reviewing your symptoms and excluding other possible causes.

Treatment is focused on maintaining good skincare (including the consistent use of sunscreen) and avoiding harsh soaps and cleaners that can damage the skin.

The twice-daily application of topical cyclosporine appears to be especially effective in treating severe cases of ocular rosacea.

Demodex

Demodex folliculorum and Demodex brevis are two types of mites that live in and around hair follicles of the face. They are usually harmless but can sometimes cause symptoms in people with weakened immune systems. The mites can cause rosacea-like symptoms, including redness, itching, dryness, and rough-looking skin.

Demodex folliculorum is the type most likely to infest eyelashes. These mites are too small to be seen with the naked eye but can be diagnosed by your doctor taking a small scraping of the affected skin and examining it under a microscope.

Demodex infestations can be treated with topical insecticides containing permethrin or crotamiton. A topical antibiotic may also be prescribed if there is cracking or oozing of the skin.

Lifestyle Risk Factors

Flaky eyelids can sometimes develop as the skin ages. Over time, the meibomian glands may not work as well as they use to, while years of sun exposure may cause premature aging of the skin.

Even people who use sunscreen regularly will often forget to apply it to their eyelids, even though the skin around the eyes is among the most delicate on the human body.

These factors can take their toll on the eyelids, causing dryness, sagging, roughness, and discoloration. If you then apply harsh chemicals to the eyelids (such as alcohol-based makeup remover or bar soap), the skin can begin to dry even further, leading to tiny cracks, flaking, and scaling.

False eyelashes and eyelash glue can also be problematic. By continually exposing the meibomian glands to these adhesive products, you risk not only clogging pores but introducing bacteria with each reuse of the lashes.

By treating your eyelids gently (using lotions and products intended solely for eyelid skin) and minimizing UV exposure (with a high SPF sunscreen and UV-protective sunglasses), you can allow flaky eyelids to heal gently, often without the need for special medications.

If problems persist despite your best home interventions, ask your doctor for a referral to a dermatologist for further evaluation.

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