What are the causes and treatments of periorbital edema?

Causes of Periorbital Edema

Periorbital edema has multiple etiologies including medication-related, infectious, inflammatory, autoimmune, allergic, traumatic, and neoplastic causes, with diagnosis requiring careful evaluation of onset pattern, laterality, and associated symptoms.

Common Causes of Periorbital Edema

Medication-Related Causes

• Imatinib therapy: Can cause periorbital edema in up to 70% of treated patients 1
• Thyroid hormone replacement: Rare cases of delayed hypersensitivity reactions to levothyroxine excipients can manifest as asymmetric periorbital edema 2

Infectious Causes

• Bacterial infections (preseptal/orbital cellulitis)
• Viral infections
• Fungal infections 3

Inflammatory and Allergic Causes

• Allergic reactions
• Contact dermatitis
• Angioedema 3

Autoimmune Conditions

• Lupus erythematosus: Both lupus panniculitis and discoid lupus erythematosus can present with periorbital edema 4, 5
• Dermatomyositis
• Thyroid eye disease 3

Trauma and Surgery

• Post-surgical edema
• Traumatic injuries 1, 6

Neoplastic Causes

• Primary or metastatic tumors 6, 3

Diagnostic Approach

Key Clinical Assessment

• Evaluate onset pattern (acute vs. gradual)
• Determine if unilateral or bilateral
• Note any diurnal variation 1
• Assess for associated fever (suggests infectious or inflammatory process) 3

Imaging Studies

• Ultrasound biomicroscopy: Particularly valuable in congenital and traumatic cases 1
• Anterior segment OCT: Helpful to visualize deeper structures when edema is present 1
• Additional imaging (CT, MRI) may be indicated based on suspected etiology 3

Treatment Approaches

Medication-Related Edema

• For imatinib-induced periorbital edema, note that diuretics have limited benefit 1
• For hypersensitivity reactions to medications, discontinuation of the offending agent is often necessary 2
• Alternative formulations with fewer excipients may be considered for medication allergies 2

Infectious Causes

• Topical or systemic antibiotics for bacterial infections
• Prophylactic broad-spectrum antibiotics when using bandage contact lenses 1

Symptomatic Management

• Hyperosmotic agents such as sodium chloride 5% drops or ointment 1
• Cold compresses
• Head elevation

Clinical Pearls and Pitfalls

• Pitfall: Dismissing periorbital edema as merely cosmetic when it could indicate serious underlying conditions
• Pearl: Fever with periorbital edema should raise suspicion for infectious or inflammatory processes that may require urgent intervention 3
• Pitfall: Failing to consider medication-related causes, which can develop even after long-term use of a medication 2
• Pearl: Asymmetric presentation does not rule out systemic causes 2

Special Considerations

• Lupus erythematosus can present initially with periorbital edema before other manifestations become apparent 4, 5
• Medication reactions may be delayed and not accompanied by typical allergic symptoms like rash or itching 2
• The presence of fever with periorbital edema warrants urgent evaluation to rule out life-threatening conditions 3