Edema of the face
Edema of the face: Excerpt from Signs & Symptoms: A 2-in-1 Reference for Nurses
Facial edema refers to either localized swelling — around the eyes, for example — or more generalized facial swelling that may extend to the neck and upper arms. Occasionally painful, this sign may develop gradually or abruptly. Sometimes it precedes the onset of peripheral or generalized edema. Mild edema may be difficult to detect; the patient or someone who’s familiar with his appearance may report it before it’s noticed during assessment.
Facial edema may result from venous, inflammatory, and certain systemic disorders; trauma; allergy; malnutrition; or the effects of certain drugs, tests, and treatments.
Emergency Actions
If the patient has facial edema associated with burns or if he reports recent exposure to an allergen, quickly evaluate his respiratory status. Edema may also affect his upper airway, causing life-threatening obstruction. If you detect audible wheezing, inspiratory stridor, or other signs of respiratory distress, administer epinephrine. For patients in severe distress — with absent breath sounds and cyanosis — tracheal intubation, cricothyroidotomy, or tracheotomy may be required. Always administer oxygen.
History
If the patient isn’t in severe distress, take his health history. Ask if facial edema developed suddenly or gradually. Is it more prominent in early morning, or does it worsen throughout the day? Has the patient gained weight? If so, how much and over what length of time? Has he noticed a change in his urine color or output? In his appetite? Take a drug history and ask about recent facial trauma.
Physical assessment
Begin the physical examination by characterizing the edema. Is it localized to one part of the face, or does it affect the entire face or other parts of the body? Determine if the edema is pitting or nonpitting, and grade its severity. (See Differentiating between pitting and nonpitting edema, page 245.) Next, take the patient’s vital signs, and assess neurologic status. Examine the oral cavity to evaluate dental hygiene and look for signs of infection. Visualize the oropharynx and look for soft-tissue swelling.
Medical causes
Abscess (periodontal)
A periodontal abscess can cause edema of the side of the face, pain, warmth, erythema, and purulent discharge around the affected tooth. The gums may be bright red and inflamed.
Abscess (peritonsillar)
A peritonsillar abscess, a complication of tonsillitis, may cause unilateral facial edema. Other key signs and symptoms include severe throat pain, neck swelling, drooling, cervical adenopathy, fever, chills, and malaise.
Allergic reaction
Facial edema may characterize local allergic reactions and anaphylaxis. With life-threatening anaphylaxis, angioneurotic facial edema may occur with urticaria and flushing. (See Recognizing angioneurotic edema.) Airway edema causes hoarseness, stridor, and bronchospasm with dyspnea and tachypnea. Signs of shock, such as hypotension and cool, clammy skin, may also occur. A localized reaction produces facial edema, erythema, and urticaria.
Chalazion
A chalazion causes localized swelling and tenderness of the affected eyelid, accompanied by a small red lump on the conjunctival surface. The patient may report increased tearing and photophobia.
Conjunctivitis
Conjunctivitis causes eyelid edema, excessive tearing, and itchy, burning eyes. Inspection reveals a thick purulent discharge, crusty eyelids, and conjunctival injection. Corneal involvement causes photophobia and pain.
Corneal ulcers (fungal)
In patients with fungal corneal ulcers, red, edematous eyelids accompany conjunctival injection, intense pain, photophobia, and severely impaired visual acuity. Copious, purulent eye discharge makes eyelids sticky and crusted. The characteristic dense, central ulcer grows slowly, is whitish gray, and is surrounded by progressively clearer rings.
Dacryocystitis
With dacryocystitis, lacrimal sac inflammation causes prominent eyelid edema and constant tearing. In acute cases, pain and tenderness near the tear sac accompany purulent discharge.
CULTURAL CUE:
Dacryocystitis rarely occurs in blacks because they tend to have a larger nasolacrimal ostium and a shorter, straighter lacrimal canal than whites.
Facial burns
Burns may cause extensive edema that impairs respiration. Additional findings include singed nasal hairs and eyebrows, red mucosa, sooty sputum, and signs of respiratory distress, such as inspiratory stridor.
Facial trauma
With facial trauma, the extent of edema varies with the type of injury. For example, a contusion may cause localized edema, whereas a nasal or maxillary fracture causes more generalized edema. Associated signs and symptoms also depend on the type of injury.
Herpes zoster ophthalmicus
With herpes zoster ophthalmicus (also known as shingles), edematous and red eyelids are usually accompanied by excessive tearing and a serous discharge. Severe unilateral facial pain may occur several days before vesicles erupt. Fever and malaise may also occur.
Hordeolum
Typically, localized eyelid edema, erythema, and pain occur with a hordeolum (stye). The patient may report photophobia and a foreign body sensation.
Malnutrition
Severe malnutrition causes facial edema followed by swelling of the feet and legs. Associated signs and symptoms include muscle atrophy and weakness; anorexia; diarrhea; lethargy; dry, wrinkled skin; sparse, brittle, easily plucked hair; and slowed pulse and respiratory rates.
Myxedema
Myxedema eventually causes generalized facial edema; waxy, dry skin; hair loss or coarsening; and other signs of hypothyroidism. Upper eyelid drooping may also be apparent.
Nephrotic syndrome
Commonly the first sign of nephrotic syndrome, periorbital edema precedes dependent and abdominal edema. Associated findings include weight gain, nausea, anorexia, lethargy, fatigue, and pallor.
Orbital cellulitis
Sudden onset of periorbital edema marks orbital cellulitis, an inflammatory disorder. It may be accompanied by a unilateral purulent discharge, hyperemia, exophthalmos, conjunctival injection, impaired extraocular movements, fever, and extreme orbital pain.
Preeclampsia
Edema of the face, hands, and ankles is an early sign of preeclampsia. Other characteristics include excessive weight gain, severe headache, blurred vision, hypertension, and midepigastric pain.
Rhinitis (allergic)
With allergic rhinitis, red and edematous eyelids are accompanied by paroxysmal sneezing, itchy nose and eyes, and profuse, watery rhinorrhea. The patient may also develop nasal congestion, excessive tearing, headache, sinus pain, and sometimes malaise and fever.
Sinusitis
Frontal sinusitis causes edema of the forehead and eyelids. Maxillary sinusitis produces edema in the maxillary area as well as malaise, gingival swelling, and trismus. Both types are also accompanied by facial pain, fever, nasal congestion, purulent nasal discharge, and red, swollen nasal mucosa.
Superior vena cava syndrome
Superior vena cava syndrome gradually produces facial and neck edema accompanied by thoracic or jugular vein distention. It also causes central nervous system symptoms, such as headache, vision disturbances, and vertigo.
Other causes
Diagnostic tests
An allergic reaction to contrast media used in radiologic tests may produce facial edema.
Drugs
Long-term use of glucocorticoids may produce facial edema. Any drug that causes an allergic reaction (aspirin, antipyretics, penicillin, and sulfa preparations, for example) may have the same effect. Ingestion of the fruit pulp of ginkgo biloba can cause severe erythema and edema and the rapid formation of vesicles.
Surgery and transfusion
Cranial, nasal, or jaw surgery may cause facial edema, as may a blood transfusion that causes an allergic reaction.
Special considerations
Administer an analgesic for pain, and apply cream to reduce itching. Unless contraindicated, apply cold compresses to the patient’s eyes to decrease edema. Elevate the head of the bed to help drain the accumulated fluid. Urine and blood tests are commonly ordered to help diagnose the cause of facial edema.
Pediatric pointers
Normally, periorbital tissue pressure is lower in a child than in an adult. As a result, children are more likely to develop periorbital edema. In fact, periorbital edema is more common than peripheral edema in children with such disorders as heart failure and acute glomerulonephritis. Pertussis may also cause periorbital edema.
Patient counseling
Teach the patient with allergies about the risks of delayed symptoms (those that occur up to 24 hours after exposure to an allergen) and the need to report shortness of breath, chest tightness, sweating, angioedema, or other symptoms. Tell him to avoid exposure to known allergens, including all forms of the offending food or drug. Also advise the patient to avoid open fields and wooded areas during the insect season to prevent insect bites or stings. Advise the patient to carry an anaphylaxis kit containing epinephrine. Instruct the patient to wear a medical identification bracelet identifying his allergies and medical conditions.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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