What is the cause of sudden onset bilateral periorbital edema, tender eyelids, and mild headache in a patient taking metformin, atorvastatin, and lisinopril-hydrochlorothiazide, with no history of allergies or recent introduction of new lotions or eyelashes?

Differential Diagnosis for Swollen Eyes

• Single most likely diagnosis
  • Allergic conjunctivitis: The patient's symptoms of swollen eyes, tender eyelids, and aggravation by air could suggest an allergic reaction. Although she denies any allergies, it's possible that she may have been exposed to a new allergen or has a previously undiagnosed allergy.
• Other Likely diagnoses
  • Blepharitis: This condition involves inflammation of the eyelids and can cause swelling, tenderness, and sticking of the eyelids together. The patient's symptoms of tender eyelids and swollen eyes could be consistent with blepharitis.
  • Viral conjunctivitis: The patient's symptoms of swollen eyes, stuck together eyelids, and lack of response to cold water shower could suggest a viral infection.
  • Contact dermatitis: Although the patient denies applying any new lotions or eyelashes, it's possible that she may have come into contact with an irritant that caused a reaction.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Orbital cellulitis: This is a serious infection of the tissues surrounding the eye and can cause swelling, redness, and pain. Although the patient denies redness, it's essential to consider this diagnosis due to its potential severity.
  • Angioedema: This condition involves rapid swelling of the skin and mucous membranes and can be life-threatening if not treated promptly. The patient's symptoms of swollen eyes and tender eyelids could be consistent with angioedema, especially given her use of lisinopril-hydrochlorothiazide, which can increase the risk of angioedema.
• Rare diagnoses
  • Thyroid ophthalmopathy: This condition involves inflammation of the tissues surrounding the eye and can cause swelling, redness, and pain. Although the patient's symptoms are not typical of thyroid ophthalmopathy, it's a possible consideration given the bilateral nature of her symptoms.
  • Sjögren's syndrome: This autoimmune disorder can cause dry eyes, swelling, and tenderness of the eyelids. Although the patient's symptoms are not typical of Sjögren's syndrome, it's a possible consideration given the lack of other obvious causes.