Causes and Risk Factors of Flaky Eyelids

You may believe that dry, rough, scaly patches of skin on your eyelids are simply a result of aging or climate. There are, however, a number of common and uncommon causes of flaky eyelids to also consider.

A skin condition like eczema could be to blame, but so could a reaction to something you apply to the area. If over-the-counter ointments and moisturizers fail to improve your condition, you may have a problem that needs specific medical treatment.

This article looks at some of the possible causes of flaky eyelids and how they are treated.

Blepharitis

Blepharitis is a general term referring to inflammation of the eyelids. It causes flaking and scaling nearer to the eyelashes and usually affects both eyelids.

When you have this condition, your eyelids will appear greasy. The lashes will often stick together or crust over while you sleep. Itchiness is common.

People with blepharitis often say they feel grit beneath the eyelid. They may also experience eyelash loss due to constant rubbing and scratching. Red, watery eyes and extreme sensitivity to light are other possible symptoms.

Blepharitis has a few possible causes. These include:

• Bacterial or fungal infection
• Seborrheic dermatitis (dandruff)
• Clogged meibomian glands, which provide the eyelids with the oil layer of the tears

A tissue swab can help determine if there is a bacterial or fungal infection. Topical antibiotics or antifungals may be prescribed if an infection is identified. Steroid eye drops or ointments may reduce inflammation. These must be used with care as they can cause glaucoma and thinning of the skin of the already thin-skinned eyelids.

Atopic Dermatitis

People with atopic dermatitis (eczema) have outbreaks of red, scaly skin. Eczema can affect any part of the body. Symptoms can include:

• Dry skin
• Itching
• Tiny bumps
• Oozing
• Reddish-brown patches, especially on the eyelids

It is uncommon for eczema to affect the eyelids only, but it can happen.

Eczema symptoms can come and go. The condition may flare up only to disappear for weeks, months, or even years at a time.

Itching is often the most prominent symptom. Excessive scratching can cause inflammation and bleeding. Over time, the skin may begin to thicken and develop a cracked, scaly appearance.

Eczema is thought to be caused by environmental factors and genetic predisposition. The environmental factors may help trigger the condition.

Eczema can usually be diagnosed by sight alone. Treatment may involve:

• Moisturizing creams to hydrate the skin
• Antibiotic ointments to help fight infection

Topical steroids are usually not recommended for eczema on the eyelids. This is because they can cause irreversible skin thinning and ptosis (drooping eyelids).

If eczema symptoms are severe enough, your healthcare provider may prescribe a topical immune suppressant such as:

• Protopic (tacrolimus)
• Elidel (pimecrolimus)

These medicines are safe to use on delicate skin like the eyelids.

Contact Dermatitis

Contact dermatitis is a red, itchy rash. It is 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
• Tiny, oozing blisters

Like all allergic conditions, contact dermatitis happens when your immune system mistakes an otherwise harmless substance for a threat. The immune system releases inflammatory chemicals at the contact site, causing tissues to swell and redden.

Contact dermatitis can be caused by things you put on your eyelids or get into your eyes, such as:

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

If contact dermatitis recurs, your healthcare provider may recommend a patch skin test. This test can help determine what, if anything, you may be allergic to. During a skin patch test, an adhesive patch that contains tiny amounts of different allergens is attached to your skin. If there's any skin irritation after the patch is removed, it may mean you have an allergy.

Less commonly, oral corticosteroid drugs may be used if the symptoms are severe or persistent. These drugs are usually reserved for outbreaks on larger areas of skin, however.

Uncommon Causes

There are several uncommon causes of flaky eyelids.

Rosacea

Rosacea is a common condition. People with this condition have areas of skin redness and tiny blood vessels called "spider veins" or telangiectasia on the face.

Rosacea most commonly affects the nose, cheeks, forehead, and chin, but it can also develop on the eyelids. If this occurs, it can lead to ocular rosacea, which causes swelling of the eyelids and dry, red, and swollen eyes.

The cause of rosacea is not known for sure. It is thought to be the result of both environmental and hereditary factors. People at greatest risk for developing rosacea include:

• Light-skinned females
• Smokers
• Those with a family history of rosacea
• People who have sun-damaged skin

There are no tests to diagnose rosacea. Healthcare providers usually identify the condition based on your symptoms and the exclusion of other possible causes.

Conservative treatment includes consistent use of sunscreen, and avoiding harsh soaps and cleaners that can damage the skin. Good lid hygiene, warm compresses, and artificial tears are used. Blepharitis from ocular rosacea may be treated with topical antiseptics and antibiotics.

Ocular rosacea may also be treated with oral antibiotic therapy. Topical anti-inflammatory agents may be used.

Demodex

Demodex folliculorum and Demodex brevis are tiny 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
• 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. A healthcare provider can identify them by taking a small scraping of the affected skin and examining it under a microscope.

This condition can be treated with over-the-counter (OTC) tea tree oil or products derived from it. Cliradex contains terpinen-4-ol (T40) derived from tea tree oil. It's applied as a foam or via a towelette.

Your healthcare provider may recommend hypochlorous acid and ointments. They may prescribe other products. A topical antibiotic may also be prescribed if the skin is cracking or oozing.

Lifestyle Risk Factors

Flaky eyelids can sometimes develop as the skin ages. Over time, the meibomian glands may not work as well as they used to.

The skin around the eyes is among the most delicate on the human body. Even so, many people forget to apply sunscreen to the eyelids. Years of sun exposure can cause premature aging of the skin.

Over time, these things can cause dryness, sagging, roughness, and discoloration of the eyelids. If you also apply harsh chemicals such as alcohol-based makeup remover or bar soap to your eyelids, the skin can develop tiny cracks, flaking, and scaling.

Treat your eyelids gently with lotions and products intended solely for eyelid skin. Minimize UV exposure with a high SPF sunscreen and UV-protective sunglasses. Taking these steps will help your flaky eyelids heal gently, often without the need for special medications.

If problems persist despite these at-home interventions, ask your healthcare provider for a referral to a dermatologist or an eye doctor who specializes in the eyelids.

Summary

Dry, rough, scaly patches of skin on your eyelids can have a number of possible causes. The most common include inflammation of the eyelids, and skin conditions like atopic dermatitis and contact dermatitis. Less common causes include rosacea and demodex, a type of mite.

You can care for your flaky eyelids with gentle products designed for use on the eyes and by limiting your exposure to the sun. If symptoms persist, have your healthcare provider refer you to a dermatologist.