Periorbital Swelling 3 Weeks Post-Operative D&C: Management
Periorbital swelling occurring 3 weeks after dilation and curettage is not a recognized complication of gynecologic D&C procedures and requires urgent evaluation for unrelated systemic or ocular pathology.
Critical Assessment Required
The temporal relationship between D&C and periorbital swelling at 3 weeks post-operatively is highly unlikely to be causally related, as gynecologic D&C procedures do not involve the periorbital region or structures that would produce delayed facial edema 1.
Immediate Diagnostic Priorities
Rule out infectious causes first:
- Examine for fever, pain with eye movement, proptosis, restricted extraocular movements, and relative afferent pupillary defect to distinguish orbital cellulitis from preseptal cellulitis 2
- Orbital cellulitis is an emergency requiring immediate CT imaging of orbits and sinuses, parenteral antibiotics, and potential surgical intervention 2
- Look for unilateral versus bilateral presentation, as unilateral swelling with systemic signs demands urgent imaging 2
Assess for inflammatory or systemic causes:
- Persistent periorbital edema with conjunctival injection may indicate cutaneous lupus erythematosus, even before skin manifestations appear 3
- Evaluate for medication-related causes, as periorbital edema commonly results from systemic medications initiated perioperatively 1
- Consider allergic reactions to postoperative medications or environmental exposures 1
Examination Specifics
Perform slit-lamp biomicroscopy to evaluate:
- Ocular surface integrity and anterior segment inflammation 4
- Presence of conjunctival injection, chemosis, or discharge 2
- Intraocular pressure, as elevated IOP with corneal edema can present with periorbital swelling 4
Document discharge characteristics if present:
- Color, consistency, spontaneity, and laterality 5
- Normal tear duct discharge is clear or mucoid; purulent discharge suggests infection 5
Management Algorithm
If infectious signs present (fever, pain, restricted movement, proptosis):
- Obtain urgent CT orbit and sinuses 2
- Initiate parenteral broad-spectrum antibiotics immediately 2
- Arrange urgent ENT consultation for potential endoscopic sinus surgery 2
If inflammatory without infection:
- Consider topical corticosteroids if intraocular inflammation is present, after ruling out infection 4
- Evaluate for systemic inflammatory conditions requiring rheumatology referral 3
If medication-related:
- Review all perioperative and current medications 1
- Discontinue suspected offending agents and observe for resolution 1
If no clear etiology identified:
- Schedule follow-up within 1-2 weeks to monitor progression 5
- Consider systemic workup including renal function, thyroid function, and autoimmune markers 1
Common Pitfalls
Do not assume the swelling is related to the D&C procedure - gynecologic procedures do not cause delayed periorbital edema, and this assumption delays diagnosis of potentially serious conditions 1, 2.
Do not treat empirically as preseptal cellulitis without thorough examination - missing orbital cellulitis leads to vision-threatening and life-threatening intracranial complications 2.
Do not dismiss bilateral periorbital edema as benign - it may represent systemic disease including renal, cardiac, thyroid, or autoimmune pathology requiring comprehensive evaluation 1, 3.