Periorbital Edema

Periorbital edema is a medical condition in which the tissues around the eyes become swollen, creating the appearance of puffy eyes. The inflammation is accompanied by the buildup of fluid around the eyes, hence the actual name. The condition can be acute but it can also appear as a chronic problem, due to aging and other pre-existing medical problems. In order to treat the periorbital edema, one can use symptomatic treatments but it is more important to address the underlying health problem. Once the underlying illness has been successfully treated, the periorbital edema will disappear as well.

Periorbital Edema Symptoms

These are the most common symptoms that are encountered in patients diagnosed with periorbital edema:

• Inflammation around the eyes (can range from mild to severe)
• In case of severe inflammation, the patient’s vision is affected (the vision becomes blurry or double; in even more severe cases, the vision is lost for a temporary period of time)
• Redness is also present at the same time with the inflammation
• Abnormal protrusion of the eyeball (condition which is also known as proptosis)
• Chemosis (inflammation) of the eye sclera is present as well
• Excessive production of tears
• Bruising may occur at the level of the affected eye, due to the circulatory changes
• Retraction of the eyelids (the lids are practically wide open, due to the excessive inflammation)
• The patient might also present increased sensitivity to light
• The patient might experience intense pain in the affected eye (movement of the eyelids is no longer possible or avoided, due to the intense pain that is generated by the actual movement of the eye)
• Itchiness or burning sensation can be present (especially if the condition is caused by an allergic reaction)
• In case the periorbital edema is caused by a severe allergic reaction, the patient can present systemic involvement, with life-threatening symptoms (rapid heart rate, difficulty in breathing or swallowing – requires immediate medical intervention, before vascular shock occurs or the patient suffocates, due to the airways tightening)
• In case of infection, the patient might present systemic symptoms as well, including high-running fever, state of general malaise, nausea and vomiting
• Patients who experience periorbital edema due to infection may also present tenderness at the level of the local lymph nodes (due to the infection, these are swollen and tender to the touch)

What Causes Periorbital Edema?

These are the most common causes that can lead to the appearance of periorbital edema:

• Mononucleosis
• Infectious, viral disease, commonly transmitted through saliva (the kissing disease)
• The periorbital edema is one of the symptoms of this condition, appearing in the early stage of the infection
• Lack of sleep or sleeping for too much
• If a person suffers from sleep deprivation or, on the contrary, oversleeps, the periorbital edema is going to appear as a sign of the disturbed sleeping cycle
• Fluid retention
• Pregnancy
• Menstruation (due to the hormonal variation)
• Kidney problems
• Diet
• Excess salt – a diet that is rich in salt leads to the retention of fluid in the subcutaneous tissues and, hence to the appearance of periorbital edema
• A change in diet can be necessary in order to eliminate the periorbital edema (combined with physical exercise, so as to remove the excess salt from the body)
• Drinking high quantities of alcohol
• If a person drinks a lot of alcoholic beverages, these cause the body to become dehydrated and the existent fluids to be kept at the level of the subcutaneous tissues (which leads to the appearance of periorbital edema)
• Smoking
• Smoking can have a negative impact on the health of the body, aggravating problems related to stress and fatigue, causing hormonal imbalances as well (all of these lead to fluid retention and favor the appearance of periorbital edema)
• Allergies
• The allergic reaction to different allergens (food, animal hair, pollen, dust or chemical substances) can lead to the inflammation of the capillaries of the subcutaneous tissue (causing the periorbital edema and the additional systemic, potentially life-threatening symptoms)
• Skin disorders
• The periorbital edema is often encountered in people who are suffering from dermatitis, especially in women
• Aging
• As we age, we also tend to lose a lot of water, which can lead to fluid retention and the appearance of mild periorbital edema
• Crying
• The process of crying leads to the mild and temporary periorbital edema
• Thyroid disorders
• Both hypothyroidism and hyperthyroidism can lead to the periorbital edema, accompanied by the facial swelling (due to the hormonal imbalances)
• Periorbital cellulitis
• This is a severe infection, which can lead to a severe periorbital edema as well (emergency treatment is required, before the infection becomes life threatening)
• Chagas disease
• This condition is also known as American trypanosomiasis, representing a tropical parasitic disease, which is transmitted through insects (kissing bugs)
• Pathognomonic sign – periorbital edema that affects only one side of the body (no pain present, despite the severe inflammation)
• Nephrotic syndrome
• Due to the kidneys not functioning normally, the body starts to retain fluids, with the tissues around the eyes being the first ones to suffer from such changes
• Trichinosis
• This condition is caused by the consumption of raw or insufficiently cooked pork meat (infected with a roundworm, known as trichina worm)
• Apart from the periorbital edema, the patients also present high-running fever and intense muscle pain
• Tear glands
• If the tear glands do not function adequately, the patient can suffer from periorbital edema, among other symptoms
• Obstruction of the superior vena cava
• The obstruction of the superior vena cava can lead to periorbital edema, along with other symptoms, such as difficulty swallowing, stridor or shortness of breath
• Other causes
• Cavernous sinus syndrome polyneuropathy
• Chronic cutaneous lupus erythematosus
• Sinusitis (orbital cellulitis is a complication of this condition)
• Blepharitis (inflammation present at the margins of the eyelids)
• Conjunctivitis (inflammation of the eye conjunctiva)
• Corneal abrasion or ulcer (keratitis)
• Inflammatory conditions of the orbital (pseudotumors at the level of the orbit, reactive hyperplasia)
• Infection of the eyelids or the tissues surrounding the eyes
• Stye (bacterial infection localized at the level of the oil glands or at the eyelash follicle)
• Blunt trauma to the eye
• Foreign objects that penetrate the eye
• Exposure to chemical or toxic substances
• Injury to the head, leading to hematoma
• Insect bites/stings
• Fractures of the orbital bones or of the other bones of the skull

How is Periorbital Edema Diagnosed?

These are the most common methods used for the diagnosis of periorbital edema:

• Physical examination of the patient
• Patient anamnesis – identification of:
• Similar problems in the past
• Pre-existing health conditions that might have led to such problems
• Allergies to different products or substances
• Hematological, biochemical and serological testing – identification of antibodies (in case of allergy suspicion)
• Tests for thyroid functioning + blood testing (identification of blood-circulating thyroid hormones levels)
• Skin biopsy might be performed in the situation of dermatitis or chronic conditions of the skin, such as lupus erythematosus
• Imaging studies might be performed in the situation that the diagnosis is not clear and also to visualize the involved structures (CT or MRI)

Treatment

These are the most common methods of treatment and measures recommended for periorbital edema:

• Change of diet – reduction of salt intake and increase of hydrating fluids quantity (water in particular or water with electrolytes)
• Cold compresses can be used in order to reduce the intensity of the periorbital edema (not recommended in severe cases, solution available only for the inflammation that is mild)
• Corticosteroids – topical or oral administration, can help with the reduction of inflammation and also contribute to the improvement of the other symptoms (cannot be administered for prolonged periods of time, due to their negative effects over the general health). The most recommended choices include hydroxychloroquine and prednisone.
• Anti-inflammatory medication – topical or oral administration, can reduce the inflammation and also the pain or discomfort experienced by the patient.
• Anti-histamines – recommended in case of an allergic reaction (oral or topical administration). The oral administration is recommended for the more severe allergy cases.
• Adrenaline – standard emergency treatment in case of a severe anaphylactic reaction, with the patient having difficulties breathing or swallowing (suffocation risk, vascular collapse)
• Surgical intervention – required in the situation that the periorbital edema is caused by a serious infection (requiring drainage) or a fracture
• Antibiotics might be administered in the post-surgical period, as to reduce the risk of secondary bacterial infections.

Pictures

Collection of Pictures of Periorbital edema...