Periorbital swelling

Background

Right eye lacrimal system consisting of: of lacrimal gland (a), punctums (b,e), canalicules (c,f), lacrimal sac (g,d).

Clinical Features

Periorbital swelling images

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  Blepharitis

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  Blepharitis of eyelashes.

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  Infant Blepharitis (right)

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  Orbital cellulitis

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  Retrobulbar hemorrhage

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  Periorbital cellulitis

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  Dacryocystitis

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  Bilateral dacryoadenitis

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  Chalazion

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  External stye

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  Internal stye

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  Acute allergic conjunctivitis

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  Chronic allergic conjunctivitis

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  Contact blepharoconjunctivitis

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  Proptosis due to retrobulbar abscess and orbital cellulitis

Differential Diagnosis

Periorbital swelling

Proptosis

• Normal IOP
  • Orbital cellulitis
  • Orbital pseudotumor
  • Orbital tumor
• Increased IOP
  • Retrobulbar abscess
  • Retrobulbar emphysema
  • Retrobulbar hemorrhage
  • Ocular compartment syndrome
  • Orbital tumor

No proptosis

• Periorbital cellulitis/erysipelas
• Dacryocystitis (lacrimal duct)
• Dacryocele/Dacryocystocele
• Dacryostenosis
• Dacryoadenitis (lacrimal gland)
• Allergic reaction
• Nephrotic Syndrome (pediatrics)

Lid Complications

• Blepharitis (crusts)
• Chalazion (meibomian gland)
• Stye (hordeolum) (eyelash folicle)

Other

• Subperiosteal abscess
• Orbital abscess
• Cavernous sinus thrombosis
• Conjunctivitis
• Contact dermatitis
• Herpes zoster
• Herpes simplex
• Sarcoidosis
• Granulomatosis with polyangiitis

Evaluation

• Eye exam

Management

• Diagnosis dependent

Disposition

• Diagnosis dependent

See Also

• Periorbital vs Orbital Cellulitis

Eye Algorithms

• Red eye
  • Bilateral red eyes
  • Unilateral red eye
  • Red eye (by symptoms)
  • Red eye (peds)
    • Neonatal conjunctivitis
• Periorbital swelling
• Acute vision loss (noninflamed)
• Acute onset flashers and floaters
• Painful eyes with normal exam
• Neonatal eye problems