Periocular Steroid-Induced Skin Changes in a Pediatric Patient: Highlighting the Need for Improved Eye Drop Delivery Systems — A Case Report and Literature Review

Background: Cutaneous atrophy with hypopigmentation is well documented following dermal or injectable corticosteroid use in adults; however, similar presentations in pediatric patients, particularly those related to ophthalmic preparations, are rarely reported. Case Presentation: A 4.5-year-old child with allergic conjunctivitis developed localized cheek skin atrophy with a hypopigmented patch while using topical glucocorticoid eye drops without medical supervision. The child exhibited poor cooperation during administration, leading to repeated attempts and spillage from the bottle. Ophthalmic examination revealed no intraocular abnormalities, and discontinuation of the glucocorticoid was advised. Fear-related behavior during pediatric eye drop administration increases local exposure, medication spillage, and reduces effective dosing. A review of the literature also indicates a risk of systemic absorption associated with ophthalmic agents in pediatric eye care. Contributing factors include thin periocular skin, enhanced percutaneous absorption, persistent contact, and drug potency and formulation. Conclusion: Caregiver education and medical supervision are essential for the safe use of pediatric eye drops. Furthermore, this report highlights the need for improved eye drop delivery systems that ensure accurate dosing, reduce medication wastage, improve treatment adherence, and minimize the risk of local or systemic adverse effects.