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
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Conjunctivitis
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Allergy
–Systemic (e.g., reaction to medication,
urticaria/angioedema)
–Local (e.g., insect bite)
-
Contact dermatitis/dermatitis medicamentosa
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Chalazion
–Zeis or Meibomian gland obstruction of eyelid
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Orbital disease (see “Proptosis/Exophthalmos” entry)
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Preseptal/periorbital cellulitis
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Acute dacryocystitis (infection of the lacrimal ducts)
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Orbital fat herniation through attenuated or dehiscent orbital septum and/or orbicularis oculi muscle (aging changes)
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Herpes simplex/zoster
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Blepharitis/dermatitis
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Trauma/postsurgical (e.g., orbital fracture)
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Dermatomyositis/polymyositis
–Associated with a heliotropic (violet colored) rash on the upper eyelids
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Chemical, ultraviolet, or thermal burn
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Cardiac failure (generalized edema)
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Renal failure
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Nephrotic syndrome
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Blepharitis/rosacea
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Dacryoadenitis
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Hypothyroidism
–Associated with fatigue, pretibial edema, and delayed relaxation of reflexes
-
Superior vena cava syndrome
-
Sebaceous gland carcinoma
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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
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Physical exam, including a full ophthalmologic exam for erythema, tenderness, cutaneous vesicles, discharge, proptosis, vision changes, and conjunctival injection or chemosis
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Initial laboratory evaluation may include CBC with differential, electrolytes, BUN, creatinine, TSH, ESR, ANA, albumin, and urinalysis
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Culture and Gram stain of eye discharge if infection is considered
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Consider CT/MRI of orbits, neck, and/or chest as appropriate
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Consider biopsy of suspicious or persistent lesions
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Consider echocardiogram if heart failure is being considered
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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
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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 Periorbital oedema
Read excerpts from these other book chapters related to Periorbital oedema:
Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Periorbital oedema
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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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» Next page: Periorbital Edema (In A Page: Pediatric Signs and Symptoms)
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