Edema of the face

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 results from disruption of the hydrostatic and osmotic pressures that govern fluid movement between the arteries, veins, and lymphatics. (See Understanding fluid balance,page 225.) It may result from venous, inflammatory, and certain systemic disorders; trauma; allergy; malnutrition; or the effects of certain drugs, tests, and treatments.

Action stat!

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 the patient in severe distress—with absent breath sounds and cyanosis—tracheal intubation, cricothyroidotomy, or tracheotomy may be required. Always administer oxygen.

History and physical examination

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.

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 Edema: Pitting or nonpitting?page 226.) Next, take the patient's vital signs, and assess his 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

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.

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.

Dacryoadenitis.Severe periorbital swelling characterizes dacryoadenitis, which may also cause conjunctival injection, purulent discharge, and temporal pain.

Dacryocystitis.Lacrimal sac inflammation causes prominent eyelid edema and constant tearing. With acute cases, pain and tenderness near the tear sac accompany purulent discharge.

Facial burns.Burns may cause extensive edema that impairs respiration. Additional findings include singed nasal hairs, red mucosa, sooty sputum, and signs of respiratory distress such as inspiratory stridor.

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 features also depend on the type of injury.

Herpes zoster ophthalmicus (shingles).With 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.

Myxedema.Myxedema eventually causes generalized facial edema; waxy, dry skin; hair loss or coarsening; and other signs of hypothyroidism.

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.The sudden onset of periorbital edema marks orbital cellulitis. It may be accompanied by a unilateral purulent discharge, hyperemia, exophthalmos, conjunctival injection, impaired extraocular movements, a fever, and extreme orbital pain.

Periodontal abscess.A periodontal abscess can cause swelling or edema of the gums and can progress to cause facial edema, ear and jaw pain, as well as tooth pain.

Preeclampsia.Edema of the face, hands, and ankles is an early sign of preeclampsia. Other characteristics include excessive weight gain, a severe headache, blurred vision, hypertension, and midepigastric pain.

Rhinitis (allergic).With 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, a headache, sinus pain and, sometimes, malaise and a 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, a 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 a headache, vision disturbances, and vertigo.

Trachoma.With trachoma, edema affects the eyelid and conjunctiva and is accompanied by eye pain, excessive tearing, photophobia, and eye discharge. Examination reveals an inflamed preauricular node and visible conjunctival follicles.

Trichinosis.Trichinosis is a relatively rare infectious disorder that causes the sudden onset of eyelid edema with a fever (102° to 104° F [38.9° to 40° C]), conjunctivitis, muscle pain, itching and burning skin, sweating, skin lesions, and delirium.

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 (described as “moon face”). Any drug that causes an allergic reaction (aspirin, antipyretics, penicillin, and sulfa preparations, for example) may also cause edema.

Surgery and transfusion.Cranial, nasal, or jaw surgery may cause facial edema, as may a blood transfusion that causes an allergic reaction.

Nursing considerations

▪ Administer an analgesic for pain.

▪ 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.

Patient teaching

▪ Explain the risks of delayed allergy symptoms.

▪ Explain which signs and symptoms the patient or family should report.

▪ Emphasize the importance of having an anaphylaxis kit and medical identification bracelet.

▪ Explain to the patient the underlying cause of edema and its treatment.

Pictures

Book Source Details

• Book Title: Nursing: Interpreting Signs and Symptoms
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7

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