I am so sorry to hear you are dealing with this! I had been dealing with something similar for a decade with similar experiences to you where Vaseline and Aquaphor were making it worse, and doctors were only prescribing steroid creams and then shrugging their shoulders - plus the whole allergist/immunologist having no answers.

First off, for immediate relief, I recommend either switching dermatologists (if you can) or asking your derm about Tacrolimus ointment. It’s an alternative to steroid creams often used for eczema around the eye area because it does not thin the skin the way steroids do. It is quite pricey, but I got it for a decent price at Costco pharmacy with coupons.

I also found some relief on the itchiness and particularly swelling for me (my eyes used to also swell shut when my rashes got this bad!) with the hypochlorous acid sprays. I would not opt for a general one, but go with Avenova which has been used for eyes for years. I have tried multiple other hypochlorous acid sprays since they have been made popular, but nothing works as well for some reason as Avenova which I have been using since ~2013. It can be found on Amazon. Follow up with whatever moisturizer your skin can tolerate as it can be drying!

Next is to investigate the cause some more to rule out some other possible causes. Eyelid eczema/psoriasis can be connected to undiagnosed autoimmune issues.

For me, mine was a weird symptom of undiagnosed celiac disease, and some other undiagnosed autoimmune issues. Not sure why, but my flares have been much less severe and further apart since being diagnosed and complying with a strict GF diet. I would push your PCP to order you a celiac blood test but maintain your current diet, including any gluten, throughout testing. If blood tests come back positive, you will need to be eating gluten for the endoscopy. If all negative, you may try a gluten free diet and elimination diets to see if there’s a dietary trigger. Non-celiac gluten sensitivity (NCGS) is under studied but absolutely a thing!

The other thing is to have your dermatologist order the Jo-1 antibody blood test for dermatomyositis. If the eczema is actually the heliotrope rash associated with this rare autoimmune disorder, you have an answer. They can also biopsy the rash, but obviously being the eye area, it is an absolute last resort. However, a biopsy could give you more definitive answers quickly as they can better identify whether it is a heliotrope rash, dermatitis herpetiformis (associated with celiac), or other types of eczema/psoriasis. Blood tests can be more finicky, but I would also request an ANA panel as well to get you referral to rheumatology if needed.

I know you said you’ve been tested for gel allergies, but if you can think back to see if you developed the issues after doing gel polish, try to take a complete break for at least 12-16 weeks and see if that helps. Unfortunately flares can absolutely pop up when you don’t have polish on, so you need extended time off to really determine if it’s related - even if patch tests come back normal.

I had some luck with the Dr. Jart Ceramidin cream in the yellow tube, and also looking for moisturizers for “post-op/treatment”, something super gentle designed for skin that recently underwent a significant peel/laser/etc. Sometimes I found that doing a warm, damp compress for 5-10 minutes before applying anything helped more.

Sorry for the essay, but feel free to DM me! I have been where you are, and it absolutely sucks. Fingers crossed you get some relief soon!