Periocular Dryness

Introduction

The periocular region encompasses the delicate skin surrounding the eyes, including the upper and lower eyelids, and represents a critical interface between dermatological and ocular health.

The skin in the periocular area is, at times, only 0.2 mm thick¹ and contains a rich vascular network, fine hairs and sebaceous glands^2,3. The outermost layer of the skin (the stratum corneum) in the periocular region, is up to 10 times thinner and has fewer lipids compared to skin on other parts of the face and body⁴.

These physiological differences can have a profound effect on the skin barrier. A good skin barrier keeps external irritants out and keeps hydration in. When the skin barrier is weakened, the skin becomes dehydrated, the skin barrier becomes compromised, making it easier for irritants to enter, which can lead to inflammation.

Periocular skin is more susceptible to dehydration and without adequate moisture, the skin can appear dry, flaky, and even make fine lines or wrinkles become more visible^6,7. Mechanically, the periocular region is exposed to frequent movement (such as blinking) or manipulation (such as eye rubbing and the application or removal of eye cosmetics), which can further challenge barrier integrity⁸.

As a result, the eyelids and periocular region is among the most vulnerable and sensitive areas of the body, as well as being one of the areas with the greatest environmental and cosmetic exposure⁵.

Despite its importance, the periocular area is frequently overlooked in routine clinical practice, even though conditions affecting this region can indirectly influence ocular comfort, tear film stability, and overall patient quality of life.³

The significance of periocular health within the broader context of ocular surface disease (OSD) is becoming more recognised, especially as patient awareness and cosmetic product use continues to grow. The eyelid is subject to a number of disorders, including meibomian gland dysfunction, dry eye disease, blepharitis, allergic and dermatological conditions³. Further, contact lens use and therapeutic drugs, such as glaucoma medications, can also affect the eyelid region. These eyelid disorders, as well as external stressors such as environmental pollutants and cosmetics, can compromise the integrity of the periocular skin barrier, leading to dryness.⁹

Maintaining periocular skin health is crucial not only for aesthetic and comfort reasons but also for preserving the stability of the tear film. There is a strong association between dry skin and dry eyes¹⁰. For clinicians, understanding and assessing periocular health should be an integral component of holistic ocular surface management.^11,12

Clinical Evaluation

The different risk factors associated with periocular skin dryness¹³

• Weather: Cold, hot, windy, sun
• Climate/low relative humidity
• Hot water
• Pollution
• Older age
• Some medicated eye drops
• Cosmetics

The different signs associated with periocular dryness

• Patches of red or scaly skin​
• Flaky or peeling skin​
• Rough skin​

The different symptoms associated with periocular dryness

• Tightness
• Tingling​
• Stinging Pain​
• Burning
• Dryness ​
• Itching​

Dermatological and ocular conditions which can present with a damaged skin barrier:

• Contact dermatitis
• Atopic dermatitis
• Psoriasis
• Anterior blepharitis

Examination should begin with a comprehensive patient history. Key questions should include the duration and speed of onset of symptoms, known allergies, occupational and environmental exposures, recent changes in personal care routines, and use of ophthalmic or cosmetic products such as make-up removers or eye creams. Next, a close visual inspection of the eyelids and surrounding skin, taking note of both the affected area and of the rest of the face and neck, more generally. As the periocular region is prone to both local and systemic influences, it is important to consider dermatologic conditions such as seborrheic dermatitis, rosacea, and atopic eczema, in addition to allergic or irritant contact dermatitis resulting from exposure to cosmetics, skincare products, or topical medications.¹⁴

Knowing what to look for is key in understanding what management and advice should be administered to the patient.

Management & Advice

Management of periocular dryness requires a strategy that restores the function of the skin barrier and minimises exposure to irritants.

First-line management includes recommending simple creams or emollients suitable for the sensitive region of the dry eyelids and surrounding skin to soothe and hydrate trhe affected area. Ideal formulations are gentle and fragrance-free. Products should be ophthalmologically safe, tested, and designed to hydrate and repair the damaged skin barrier. Products that promote ceramides in the skin and contain hydrating ingredients (humectants) are particularly beneficial for restoring skin hydration and supporting barrier function.^15,16,17,18

Non-Pharmacological

• Keep periocular skincare routine simple
• Ensure the periocular region is kept clean, using with gentle cleansers
• Incorporate an Ophthalmologically tested cream to be applied to the affected area
• Protect skin against UV exposure by using sunscreen, wearing sunglasses and hates, and seeking shade
• Remove known allergens/allergic causes (refer for patch testing, where appropriate and necessary)
• If the skin is damaged or broken, stop using colour cosmetic products until barrier function is restored
• Keep up with emollient use, even between flares, to maintain a healthy skin barrier

Pharmacological^19,20

• For Dermatitis:
  • Topical corticosteroids (for use as a short course in flare ups)
  • Topical calcineurin inhibitors (Suitable for longer term use)
    • Protopic (tacrolimus 0.1% ointment) (can burn when first applied)
    • Elidel (pimecrolimus 1% cream)
• For seborrheic dermatitis:
  • Antifungals (e.g. ketoconazole shampoo, miconazole cream)

Patient education plays a key role in long-term management of periocular dryness. Advice should be focused on periocular skin hydration and cosmetic product usage.

Prevention and maintenance are equally important. Avoiding expired or irritating cosmetics, keeping the skin consistently moisturised and protected from damaging UV exposure can help preserve the periocular skin barrier and reduce dryness. Patients should be encouraged to integrate periocular skin care into their daily ocular health routine. As awareness grows, addressing periocular dryness in clinical consultations will only help improve patient comfort and outcomes.

The periocular area should be regarded as a key component of eye examinations. With appropriate education, product selection, and patient engagement, clinicians can prevent many of the common periocular issues that impact both ocular comfort and patient confidence.