Some Causes of Eyelid Swelling
Cause | Suggestive Findings | Diagnostic Approach |
|---|---|---|
Eyelid disorders | ||
Allergic reaction, local | Itching, no pain Pale, puffy eyelid or eyelids, conjunctiva, or both Sometimes history of recurrence, exposure to allergen, or both Unilateral or bilateral | History and physical examination |
Lash involvement and crusting usually visible grossly or under magnification (eg, with slit lamp) Itching, burning, redness, ulceration, or a combination Sometimes concomitant seborrheic dermatitis Unilateral or bilateral | History and physical examination | |
Focal redness and pain involving only one eyelid Eventual development of localized, nonpainful swelling away from eyelid margin | History and physical examination | |
Conjunctivitis, infectious | Conjunctival injection, discharge Sometimes preauricular node, chemosis, or both Unilateral or bilateral | |
Herpes simplex blepharitis (primary) | Clusters of vesicles on an erythematous base, ulceration, severe pain Unilateral | History and physical examination |
Herpes zoster (shingles) | Clusters of vesicles on an erythematous base, ulceration, severe pain Unilateral, V1nerve root distribution | History and physical examination, including ophthalmic examination if eye involvement is suspected |
Focal redness and pain involving only one eyelid Eventual development of swelling localized to eyelid margin, sometimes with pustule | History and physical examination | |
Insect bite | Itching, redness, sometimes a papule | History and physical examination |
Disorders in and around the orbit | ||
Cavernous sinus thrombosis (rare) | Headache, proptosis, ophthalmoplegia, ptosis, decreased visual acuity, fever Usually unilateral at first, then bilateral Manifestations of sinusitis or other facial infection | Immediate CT or MRI of brain and orbits |
Proptosis, redness, fever, pain Impaired or painful extraocular movements Sometimes decreased visual acuity Usually unilateral Sometimes preceded by manifestations of the source infection (typically sinusitis) | CT or MRI of orbits | |
Preseptal cellulitis (periorbital cellulitis) | Swelling (but not proptosis), redness, sometimes pain, fever Usually unilateral Vision and ocular motility normal Sometimes preceded by manifestations of the source infection (typically local skin infection) | CT or MRI of orbits if necessary to exclude orbital cellulitis |
Systemic disorders* | ||
Allergic reaction, systemic (eg, angioedema, rhinitis) | Itching Sometimes extraocular allergic manifestations (eg, urticaria, wheezing, rhinorrhea) Sometimes history of recurrence, exposure to allergen, atopy, or a combination Usually bilateral | History and physical examination |
Bilateral asymptomatic eyelid and sometimes facial edema; usually also edema of dependent body parts (eg, feet, presacral region) Usually manifestations of underlying disorder (eg, chronic renal disease, heart failure, liver failure, preeclampsia) Sometimes use of an angiotensin-converting enzyme (ACE) inhibitor | Testing for cardiac, hepatic, or renal disorders as clinically directed | |
Hyperthyroidism (with Graves ophthalmopathy) | Stare, eyelid lag, proptosis, impaired extraocular movements Not painful unless cornea is irritated from drying Tachycardia, anxiety, weight loss | Thyroid function tests (TSH, T4) |
Painless, bilateral diffuse facial puffiness Dry, scaly skin; coarse hair Cold intolerance | Thyroid function tests (TSH, T4) | |
* Swelling due to systemic disorders is bilateral and not erythematous. | ||
T4= thyroxine; TSH =thyroid-stimulating hormone; V1 = ophthalmic division of the trigeminal nerve. | ||