Periorbital Edema

Periorbital or eyelid edema has many possible etiologies, including mechanical, hemodynamic, infectious, inflammatory, and neoplastic causes. A careful history and physical examination are necessary to determine whether the problem is localized or generalized, and treatment should be directed at the underlying etiology.

Differential Diagnosis

• Conjunctivitis
• Allergy
  –Systemic (e.g., reaction to medication, urticaria/angioedema)
  –Local (e.g., insect bite)
• Contact dermatitis/dermatitis medicamentosa
• Chalazion
  –Zeis or Meibomian gland obstruction of eyelid
• Orbital disease (see “Proptosis/Exophthalmos” entry)
• Preseptal/periorbital cellulitis
• Acute dacryocystitis (infection of the lacrimal ducts)
• Orbital fat herniation through attenuated or dehiscent orbital septum and/or orbicularis oculi muscle (aging changes)
• Herpes simplex/zoster
• Blepharitis/dermatitis
• Trauma/postsurgical (e.g., orbital fracture)
• Dermatomyositis/polymyositis
  –Associated with a heliotropic (violet colored) rash on the upper eyelids
• Chemical, ultraviolet, or thermal burn
• Cardiac failure (generalized edema)
• Renal failure
• Nephrotic syndrome
• Blepharitis/rosacea
• Dacryoadenitis
• Hypothyroidism
  –Associated with fatigue, pretibial edema, and delayed relaxation of reflexes
• Superior vena cava syndrome
• Sebaceous gland carcinoma
• Squamous or basal cell carcinoma
• Discoid lupus
• Ocular cicatricial pemphigoid (symblepharon)

Workup and Diagnosis

• History should include symptom course, exposure history (allergens, irritants, chemicals, ultraviolet, or thermal injury), associated symptoms, past medical and family history, and medication history
• Physical exam, including a full ophthalmologic exam for erythema, tenderness, cutaneous vesicles, discharge, proptosis, vision changes, and conjunctival injection or chemosis
• Initial laboratory evaluation may include CBC with differential, electrolytes, BUN, creatinine, TSH, ESR, ANA, albumin, and urinalysis
• Culture and Gram stain of eye discharge if infection is considered
• Consider CT/MRI of orbits, neck, and/or chest as appropriate
• Consider biopsy of suspicious or persistent lesions
• Consider echocardiogram if heart failure is being considered
• Consider ophthalmology consultation

Treatment

• Treat underlying cause
• Lid hygiene and bland antibiotic ointment for blepharitis (e.g., erythromycin ophthalmic ointment)
• Topical and/or systemic antibiotics for infectious causes
• For allergic causes, remove the inciting allergen or medication; use oral antihistamines and cool compresses; and consider topical steroids for local process or systemic steroids for systemic processes
• Cold compresses and chilled, preservative-free artificial tears are generally helpful for allergic or inflammatory conditions
• Blepharoplasty for herniated orbital fat if interfering with vision or cosmetically indicated

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

Other Book Chapters Related to Ear swelling

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Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Ear swelling

• Back to symptom: Ear swelling: Introduction (review 26 causes)
• Next Book Extract About Ear swelling: Peripheral Edema (In a Page: Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Ear swelling

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

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• Edema (In A Page: Pediatric Signs and Symptoms)
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• EARACHE (Differential Diagnosis in Primary Care)
• PERIORBITAL AND FACIAL EDEMA (Differential Diagnosis in Primary Care)

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