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A 26‐Year‐Old Woman With Asthma and Bilateral Ocular Swelling

Review of systems The patient denied visual changes, sicca symptoms, malar rash, jaw pain, and oral or nasal ulcers. She had also experienced no dysphagia, gastrointestinal or genitourinary symptoms, arthritis, or arthalgias. She denied shortness of breath, cough, chest pain, and palpitations. Physical examination The patient was afebrile and had a blood pressure of 115/ 74 mm Hg, a pulse of 70 beats per minute, and a normal respiratory rate. The upper eyelids were swollen, but there were no abnormalities of vision or ocular motility. The eyelids had a yellow-orange discoloration, as shown in Figure 1, and the left lacrimal gland was moderately enlarged but nontender. There was no proptosis. The parotid and submandibular glands were of normal size, and there was no lymphadenopathy. Nasal examination showed no crusting or bleeding. The heart, lung, abdominal, skin, joint, and neurologic examinations were within normal limits.