eye disorders
Eyelid Swelling
Evaluation of Eyelid Swelling
History of present illnessshould 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. should seek symptoms of possible causes, including runny nose, itching, rash, and wheezing (systemic allergic reaction); headache, nasal congestion, and purulent nasal discharge ( Sinusitis ); toothache (dental infection); dyspnea, orthopnea, and paroxysmal nocturnal dyspnea ( Past medical historyshould include recent eye injury or surgery; known heart, liver, renal, or thyroid disease; and allergies and exposure to possible allergens. Medication 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; whether it is present 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 , which suggests a systemic cause. If a systemic cause is suspected, see the topic The following findings are of particular concern: Fever Loss of visual acuity Impaired extraocular movements Proptosis 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, Preseptal and Orbital Cellulitis , In most cases, diagnosis can be established clinically and no testing is necessary. If Preseptal and Orbital Cellulitis or 