Periorbital edema

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2] Luke Rusowicz-Orazem, B.S.

Overview

Periorbital edema refers to swelling around the eyes.

Causes

Common Causes

• Acute dacryocytosis
• Aging changes
• Allergy
• Blepharitis
• Cardiac failure
• Chalazion
• Chemical burn
• Contact dermatitis
• Dacryoadenitis
• Dermatitis
• Dermatomyositis
• Discoid lupus
• Drugs
• Herpes Simplex
• Herpes Zoster
• Hypothyroidism
• Nephrotic Syndrome
• Orbital Disease
• Orbital fat herniation
• Orbital cicarticial pemphigoid
• Preseptal/periorbital cellulitis
• Renal Failure
• Sebaceous gland carcinoma
• Squamous or basal cell carcinoma
• Superior Vena Cava Syndrome
• Thermal burn
• Trauma
• Ultraviolet burn

Causes by Organ System

Cardiovascular	Cardiac failure, Congestive cardiac failure, Obstruction of the superior vena cava, Superior vena cava syndrome
Chemical/Poisoning	Chemical burn, Tick bite on scalp, Insect bites
Dental	No underlying causes
Dermatologic	Dermatitis, Dermatomyositis, Discoid lupus, Sebaceous gland carcinoma, Thermal burn, Ultraviolet burn
Drug Side Effect	Ingenol mebutate, Nabilone, Pramipexole, Sebelipase alfa, Steroids, Sulfasalazine
Ear Nose Throat	Sinusitis
Endocrine	Athyrotic hypothyroidism sequence , Hyperthyroidism, Hypoalbuminemia, Hypothyroidism
Environmental	Insect bites
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	Hematoma, Obstruction of the superior vena cava
Iatrogenic	No underlying causes
Infectious Disease	Acute dacryocytosis, Blepharitis , Chagas disease, Conjunctivitis, Dacryoadenitis, Dermatomyositis, Eyelid infection, Herpes simplex, Herpes zoster, Hibernian fever, Keratitis, Mononucleosis, Orbital cellulitis, Orbital inflammation, Periorbital cellulitis, Postinfectious glomerulonephritis, Sinusitis , Staphylococcal infection , Stye , Trichinella spiralis, Trichinosis
Musculoskeletal/Orthopedic	Orbital bone trauma, Orbital cellulitis, Orbital cicarticial pemphigoid, Orbital disease, Orbital fat herniation, Orbital inflammation, Periorbital cellulitis
Neurologic	Abnormal sleep length, Cavernous sinus syndrome polyneuropathy, Cavernous sinus thrombosis, Melkersson-rosenthal-schuermann syndrome
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	Menstruation, Pregnancy
Oncologic	Sebaceous gland carcinoma, Squamous cell carcinoma, Tumors
Ophthalmologic	Acute dacryocytosis, Blepharitis , Chalazion, Conjunctivitis, Dacryoadenitis, Eyelid infection, Keratitis
Overdose/Toxicity	Excessive alcohol consumption, Excessive sodium consumption, Smoking
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	Excessive sodium consumption, Nephrotic syndrome, Postinfectious glomerulonephritis, Renal conditions, Renal failure
Rheumatology/Immunology/Allergy	Allergies, Chronic cutaneous lupus erythematosus, Discoid lupus
Sexual	Herpes simplex
Trauma	Eye trauma, Head trauma, Hematoma, Herniated fat, Orbital bone trauma, Orbital fat herniation, Thermal burn, Tick bite on scalp, Ultraviolet burn
Urologic	No underlying causes
Miscellaneous	Aging

Causes In Alphabetical Order

• Abnormal sleep length
• Acute dacryocytosis
• Aging changes
• Allergies
• Athyrotic hypothyroidism sequence 
• Blepharitis
• Cardiac failure
• Cavernous sinus syndrome polyneuropathy
• Cavernous sinus thrombosis
• Chagas disease
• Chalazion
• Chemical burn
• Chronic cutaneous lupus erythematosus
• Congestive cardiac failure
• Conjunctivitis
• Dacryoadenitis
• Dermatitis
• Dermatomyositis
• Discoid lupus
• Ent tumour
• Excessive alcohol consumption
• Excessive sodium consumption
• Eye trauma
• Eyelid infection
• Head trauma
• Hematoma
• Herniated fat
• Herpes simplex
• Herpes zoster
• Hibernian fever
• Hyperthyroidism
• Hypoalbuminemia
• Hypothyroidism
• Ingenol mebutate
• Insect bites
• Keratitis
• Melkersson-rosenthal-schuermann syndrome
• Menstruation
• Mononucleosis
• Nabilone
• Nephrotic syndrome
• Obstruction of the superior vena cava
• Orbital bone trauma
• Orbital cellulitis
• Orbital cicarticial pemphigoid
• Orbital disease
• Orbital fat herniation
• Orbital inflammation
• Periorbital cellulitis
• Postinfectious glomerulonephritis
• Pramipexole
• Pregnancy
• Renal conditions
• Renal failure
• Sebaceous gland carcinoma
• Sebelipase alfa
• Sinusitis
• Smoking
• Squamous cell carcinoma
• Staphylococcal infection 
• Steroids
• Stye
• Sulfasalazine
• Superior vena cava syndrome
• Tear glands
• Thermal burn
• Tick bite on scalp
• Trauma
• Trichinella spiralis
• Trichinosis
• Tumors
• Ultraviolet burn

Diagnosis

History and Symptoms

• History includes:

• Symptomatic history
• Exposure history
• Past medical history
• Family history
• Medicinal history

Eyes

• Full opthamologic exam:

• Chemosis
• Cutaneous vesicles
• Discharge
• Erythmia
• Proptosis
• Tenderness

Laboratory Findings

• Labs include:

• Albumin
• ANA
• BUN / Creatinine
• CBCD
• ESR
• TSH
• Urinalysis

• Culture of eye

• Gram stain if suspected infection

CT

• CT of eyes, head and neck if deemed necessary

Echocardiography or Ultrasound

• Consider echo if CHF is suspected

Other Diagnostic Studies

• Consider biopsy of lesions if necessary

Treatment

• Opthalmology consult

Acute Pharmacotherapies

• Treat with topical antibiotics
• If an allergy, remove allergen, add cold compress and antihistamines

References

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