Eyelid Swelling

History of present illness should ascertain how long swelling has been present, whether it is unilateral or bilateral, and whether it has been preceded by any trauma (including insect bites). Important accompanying symptoms to identify include itching, pain, headache, change in vision, fever, and eye discharge.

Review of systems should seek symptoms of possible causes, including runny nose, itching, rash, and wheezing (systemic allergic reaction); headache, nasal congestion, and purulent nasal discharge (sinusitis Sinusitis Sinusitis is inflammation of the paranasal sinuses due to viral, bacterial, or fungal infections or allergic reactions. Symptoms include nasal obstruction and congestion, purulent rhinorrhea... read more ); toothache (dental infection); dyspnea, orthopnea, and paroxysmal nocturnal dyspnea (heart failure Heart Failure (HF) Heart failure (HF) is a syndrome of ventricular dysfunction. Left ventricular (LV) failure causes shortness of breath and fatigue, and right ventricular (RV) failure causes peripheral and abdominal... read more ); cold intolerance and changes in skin texture (hypothyroidism Hypothyroidism Hypothyroidism is thyroid hormone deficiency. Symptoms include cold intolerance, fatigue, and weight gain. Signs may include a typical facial appearance, hoarse slow speech, and dry skin. Diagnosis... read more ); and heat intolerance, anxiety, and weight loss (hyperthyroidism Hyperthyroidism Hyperthyroidism is characterized by hypermetabolism and elevated serum levels of free thyroid hormones. Symptoms include palpitations, fatigue, weight loss, heat intolerance, anxiety, and tremor... read more ).

Past medical history should include recent eye injury or surgery; known heart, liver, renal, or thyroid disease; and allergies and exposure to possible allergens. Drug history should specifically include use of angiotensin-converting enzyme (ACE) inhibitors.

Vital signs should be assessed for fever and tachycardia.

Eye inspection should assess the location and color of swelling (erythematous or pale), including whether it is present on one or both eyelids of one eye or one or both eyelids in both eyes and whether it is tender, warm, or both. The examiner should observe whether the finding represents edema of the eyelids, protrusion of the globe (proptosis), or both. Eye examination should particularly note visual acuity and range of extraocular motion (full or limited). This examination can be difficult when swelling is marked but is important because deficits suggest an orbital or retro-orbital disorder rather than an eyelid disorder; an assistant may be required to hold the eyelids open. Conjunctivae are examined for injection and discharge. Any eyelid or eye lesions are evaluated using a slit lamp.

General examination should assess signs of toxicity, suggesting a serious infection, and signs of a causative disorder. Facial skin is inspected for dryness and scales (which may suggest hypothyroidism) and greasy scales or other signs of seborrheic dermatitis. Extremities and the presacral area are examined for edema Edema Edema is swelling of soft tissues due to increased interstitial fluid. The fluid is predominantly water, but protein and cell-rich fluid can accumulate if there is infection or lymphatic obstruction... read more , which suggests a systemic cause. If a systemic cause is suspected, see the topic Edema Edema Edema is swelling of soft tissues due to increased interstitial fluid. The fluid is predominantly water, but protein and cell-rich fluid can accumulate if there is infection or lymphatic obstruction... read more for further discussion of the evaluation.

The following findings are of particular concern:

Some findings help distinguish among categories of disorders. The first important distinction is between inflammation or infection and allergy or fluid overload. Pain, redness, warmth, and tenderness suggest inflammation or infection. Painless, pale swelling suggests angioedema. Itching suggests allergic reaction, and absence of itching suggests cardiac or renal dysfunction.

Swelling localized to one eyelid in the absence of other signs is rarely caused by a dangerous disorder. Massive swelling of the eyelids of one or both eyes should raise suspicion of a serious problem. Signs of inflammation, proptosis, loss of vision, and impaired extraocular movements suggest an orbital disorder (eg, orbital cellulitis Preseptal and Orbital Cellulitis Preseptal cellulitis (periorbital cellulitis) is infection of the eyelid and surrounding skin anterior to the orbital septum. Orbital cellulitis is infection of the orbital tissues posterior... read more , cavernous sinus thrombosis Cavernous Sinus Thrombosis Cavernous sinus thrombosis is a very rare, typically septic thrombosis of the cavernous sinus, usually caused by nasal furuncles or bacterial sinusitis. Symptoms and signs include pain, proptosis... read more ) that may be pushing the globe forward or affecting the nerves or muscles. Other suggestive and specific findings are listed in the table Some Causes of Eyelid Swelling Some Causes of Eyelid Swelling .

In most cases, diagnosis can be established clinically and no testing is necessary. If orbital cellulitis Preseptal and Orbital Cellulitis Preseptal cellulitis (periorbital cellulitis) is infection of the eyelid and surrounding skin anterior to the orbital septum. Orbital cellulitis is infection of the orbital tissues posterior... read more or cavernous sinus thrombosis Cavernous Sinus Thrombosis Cavernous sinus thrombosis is a very rare, typically septic thrombosis of the cavernous sinus, usually caused by nasal furuncles or bacterial sinusitis. Symptoms and signs include pain, proptosis... read more is suspected, diagnosis and treatment should proceed as rapidly as possible. Immediate imaging with CT or MRI should be done. If cardiac, liver, renal, or thyroid dysfunction is suspected, organ function is evaluated with laboratory tests and imaging as appropriate for that system.