INTRODUCTION
Periorbital skin is unique in its anatomical nature, distinguishing it from skin in other parts of the body. With periocular skin thinner than 1 to 2 mm and eyelids less than 0.6 mm thick, absorption of topical medications increases, as does susceptibility to temperature.1 Less sweat and sebaceous glands increase vulnerability to dryness and irritation from external factors. Moreover, fewer melanocytes make the eyelids more prone to ultraviolet (UV) radiation and the effects of photosensitizing agents.
Dermatologic drugs can cause various ocular complications. Corticosteroids raise intraocular pressure (IOP) and lead to skin atrophy and hypopigmentation, while retinoids cause dryness and irritation. Neomycin triggers allergic contact dermatitis, and oral antibiotics like tetracyclines and fluoroquinolones induce pigmentary changes, photophobia, and blurry vision. Immunosuppressants like methotrexate may increase the risk of eye infections, and novel biologics can cause new and emerging complications.
Familiarity with the ocular side effects of dermatologic therapeutics and a collaborative approach with specialty care is vital for timely detection-making and intervention, ensuring comprehensive and effective management.
Corticosteroids
Corticosteroids, used to reduce inflammation and pruritus, carry various side effects. The thin dermis of periocular tissue increases susceptibility to hypopigmentation, atrophy, telangiectasias, and pustulosis from excessive use (Figure 1). Low-potency steroids such as fluocinolone 0.01%, desonide 0.05%, and hydrocortisone 1.0 to 2.5% are preferred in this region.2 Posterior subcapsular cataracts may develop, leading to progressive visual loss within months to years.3 Ocular side effects may develop regardless of the route of steroid administration.
Dermatologic drugs can cause various ocular complications. Corticosteroids raise intraocular pressure (IOP) and lead to skin atrophy and hypopigmentation, while retinoids cause dryness and irritation. Neomycin triggers allergic contact dermatitis, and oral antibiotics like tetracyclines and fluoroquinolones induce pigmentary changes, photophobia, and blurry vision. Immunosuppressants like methotrexate may increase the risk of eye infections, and novel biologics can cause new and emerging complications.
Familiarity with the ocular side effects of dermatologic therapeutics and a collaborative approach with specialty care is vital for timely detection-making and intervention, ensuring comprehensive and effective management.
Corticosteroids
Corticosteroids, used to reduce inflammation and pruritus, carry various side effects. The thin dermis of periocular tissue increases susceptibility to hypopigmentation, atrophy, telangiectasias, and pustulosis from excessive use (Figure 1). Low-potency steroids such as fluocinolone 0.01%, desonide 0.05%, and hydrocortisone 1.0 to 2.5% are preferred in this region.2 Posterior subcapsular cataracts may develop, leading to progressive visual loss within months to years.3 Ocular side effects may develop regardless of the route of steroid administration.
