Periorbital Edema
The condition when fluid accumulates under the eyes is called periorbital edema.
Definition and Clinical Presentation
Periorbital edema refers to the accumulation of fluid in the tissues surrounding the eyes, specifically in the eyelid and periorbital soft tissues 1. This is a distinct entity from intraocular fluid accumulation, which would involve structures like the cornea (corneal edema) or retina (macular edema) 2.
Key Diagnostic Considerations
The causes of periorbital edema generally fall into several major categories that should guide your diagnostic approach 1:
Infectious Etiologies
- Cellulitis, abscess formation, or other infectious processes affecting the periorbital tissues 1
Inflammatory and Autoimmune Conditions
- Dermatomyositis: Periorbital edema can be the dominant or even initial presenting sign, sometimes appearing before other classic cutaneous manifestations like Gottron's papules or heliotrope rash 3, 4
- Lupus panniculitis (lupus erythematosus profundus): May present initially with periorbital edema before other systemic features become apparent 5
- Other inflammatory diseases affecting the ocular surface 2
Medication-Related Causes
- Various systemic medications can induce periorbital edema 1
Post-Surgical or Traumatic
Systemic Volume Overload
- Transplant-associated complications: Such as engraftment syndrome or thrombotic microangiopathy following hematopoietic stem cell transplantation, which can cause severe bilateral periorbital edema requiring treatment of the underlying systemic condition 6
Important Clinical Pitfall
Do not confuse periorbital edema with intraocular fluid accumulation. Corneal edema involves fluid retention within corneal layers and presents with blurred vision, photophobia, and diurnal variation (worse upon waking) 2. Macular edema involves retinal fluid accumulation and causes metamorphopsia and reduced central vision 2, 7. These are entirely different pathologic processes requiring ophthalmologic evaluation and distinct management strategies.