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 onset of peripheral or generalized edema. Mild facial 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 291.) It may result from venous, inflammatory, and certain systemic disorders; trauma; allergy; malnutrition; or the effects of certain drugs, tests, and treatments.
Emergency interventions
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 a 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 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 292.) Next, take 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 any soft-tissue swelling.
Medical causes
Abscess, periodontal
This type of abscess, which usually results from poor oral hygiene, is commonly caused by anaerobic organisms. It can cause edema of the side of the face, pain, warmth, erythema, and a purulent discharge around the affected tooth.
Abscess, peritonsillar
This 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 both a local allergic reaction and anaphylaxis. A local reaction produces facial edema, erythema, and urticaria. In 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.
Cavernous sinus thrombosis
Cavernous sinus thrombosis is a rare but serious disorder that may begin with unilateral edema that quickly progresses to bilateral edema of the forehead, base of the nose, and eyelids. It may also produce chills, fever, headache, nausea, lethargy, exophthalmos, and eye pain.
Chalazion
A chalazion causes localized swelling and tenderness of the affected eyelid, accompanied by a small red lump on the conjunctival surface.
Conjunctivitis
Conjunctivitis is an inflammation that 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
Accompanying red, edematous eyelids in this disorder are conjunctival injection, intense pain, photophobia, and severely impaired visual acuity. Copious amounts of a purulent eye discharge make the eyelids sticky and crusted. The characteristic dense, central ulcer grows slowly, is whitish gray, and is surrounded by progressively clearer rings.
Dacryoadenitis
Severe periorbital swelling characterizes dacryoadenitis, which may also cause conjunctival injection, a purulent discharge, and temporal pain.
Dacryocystitis
Lacrimal sac inflammation causes prominent eyelid edema and constant tearing. In acute cases, pain and tenderness near the tear sac accompany a purulent discharge.
Dermatomyositis
Periorbital edema and a heliotropic rash develop gradually in this rare disease. An itchy, lilac-colored rash appears on the bridge of the nose, cheeks, and forehead. Localized or diffuse erythema, eye pain, and fever may also occur.
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.
Frontal sinus cancer
This rare form of cancer causes cheek edema on the affected side, reddened skin over the sinus, unilateral nasal bleeding or discharge, and exophthalmos. Pain over the forehead and unilateral hypoesthesia or anesthesia may occur later.
Herpes zoster ophthalmicus (shingles)
In herpes zoster ophthalmicus, 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.
Hordeolum (stye)
Typically, a hordeolum produces localized eyelid edema, erythema, and pain.
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 decreased pulse and respiratory rates.
Melkersson’s syndrome
Facial edema (especially of the lips), facial paralysis, and folds in the tongue are the three characteristic signs of this rare disorder.
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
Sudden onset of periorbital edema marks this inflammatory disorder. It may be accompanied by a unilateral purulent discharge, hyperemia, exophthalmos, conjunctival injection, impaired extraocular movements, fever, and extreme orbital pain.
Osteomyelitis
When osteomyelitis affects the frontal bone, it may cause forehead edema as well as fever, chills, headache, and cool, pallid skin.
Preeclampsia
Edema of the face, hands, and ankles is an early sign of this disorder of pregnancy. Other characteristics include excessive weight gain, severe headache, blurred vision, hypertension, and midepigastric pain.
Rhinitis, allergic
In 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, a 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.
Trachoma
In 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
This relatively rare infectious disorder causes sudden onset of eyelid edema with fever (102° F to l04° F [38.9° C 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. Any drug that causes an allergic reaction (aspirin, antipyretics, penicillin, and sulfa preparations, for example) may have the same effect.
Herb Alert
Ingestion of the fruit pulp of ginkgo biloba can cause severe erythema and edema and the rapid formation of vesicles. Feverfew and chrysanthemum parthenium can cause swelling of the lips, irritation of the tongue, and mouth ulcers. Licorice may cause facial edema and water retention or bloating, especially if used before menses.
Surgery and transfusion
Facial edema may result from cranial, nasal, or jaw surgery or from 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.
Pictures
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
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Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Facial paralysis
» Next page: Facial pain (Professional Guide to Signs & Symptoms (Fifth Edition))
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