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2.07 Periorbital and Conjunctival Edema


Presentation

The patient is frightened by the facial distortion and itching that seem to appear spontaneously or up to 24 hours after having been bitten by a bug or having contacted some irritant. The patient may have been rubbing his eyes: in fact, an allergen or chemical irritant on the hand may cause periorbital edema long before a reaction, if any, is evident on the skin of the hand. There may be minimal to marked generalized conjunctival swelling (chemosis), but little injection. Tenderness and pain should be minimal or absent and there should be no erythema of the skin, photophobia or fever. Visual acuity should be normal, there should be no fluorescein uptake over the cornea and the anterior chamber should be clear.

What to do:

What not to do:

Discussion

The dramatic swelling that often brings a patient to an emergency department occurs because of the loose connective tissue surrounding the orbit. Fluid quickly accumulates when a local allergic-response causes increased capillary permeability, resulting in dramatic eyelid swelling. The envenomation, allergen, or irritant responsible may actually be located some distance away on the face (or hand) but the loose periorbital tissue is the first to swell.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD