Eye swelling

 

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Introduction

There are a number of potential causes of swelling around the eye skin, some more common than others.


Common causes swelling around the eyes

Angioedema is not uncommon but would expect it to come and go and move location within around 24 hours or so. It is often accompanied by hives/urticaria. Antihistamines will often help treatment or prevention.

Contact allergic dermatitis is a common condition causing itching and burning followed by swelling and then often healing by the skin going dry and rough as it disappears.

"Allergic shiners" in someone with hay fever can cause subtle puffiness around the eyes and sometimes in appearance of darker skin.

Rosacea can also cause non-specific facial redness and puffiness, pimples years after acne should have disappeared and easy flushing.


Less common causes of swelling around the eyes

Blepharochalasis with swelling around the upper and lower eyelids, and with thyroid enlargement (goitre) observed in between 10 and 50% of patients. This condition typically starts in adolescence and is associated with vascular dilatation and leakage of fluid into the tissues. Then there are less common causes of swelling around the eyes.

Graves’ disease of the thyroid gland can cause swelling around the eyelids but generally because the eyeball itself is pushed forward and one would expect this condition to be fixed and not fluctuate significantly. 

Orofacial granulomatosis (also known as granulomatous chelitis, Melkersson Rosenthal syndrome) is a very uncommon condition, occurring on its own or associated with inflammatory bowel disease. It is relatively easy to diagnose in retrospect in patients present with permanent rubbery swollen lips, but is less easy to diagnose when patients present early on in life. It can involve the eyes, just not very often.

Ascher's syndrome is another occasional cause of recurrent face and lip swelling, cause unknown. This condition is characterised by the appearance of a double upper lip which can look swollen, but the idea is not normally involve.

OTHER - Trauma can also cause swelling but one would expect it to be associated with a history of trauma and localised bruising.

Other less common conditions include orbital cellulitis, chronic sinusitis, orbital pseudotumour (but one would expect the eyeball itself to be pushed forward as well), localised skin amyloid associated with dark pigmentation and often bruising, orbital polymyositis (but this would normally be associated with pain, red eye and forward projection of the eyeball and not just the ocular skin or occasionally SLE.

Last reviewed 19 June 2020