Differential Diagnosis for Swollen Eyes in a 45-year-old Female
- Single most likely diagnosis:
- Allergic reaction or angioedema: Although the patient denies any allergies, the sudden onset of bilateral eyelid swelling, especially after lying down, could suggest an allergic reaction. The fact that the swelling has decreased with ice application and the absence of other symptoms like redness, itching, or drainage supports this possibility.
- Other Likely diagnoses:
- Periorbital edema: This condition can occur due to fluid retention, which might be exacerbated by the patient's supine position. The use of hydrochlorothiazide, a diuretic, might seem counterintuitive, but its effect can vary, and other factors like hormonal changes or salt intake could contribute to fluid retention.
- Blepharitis: Although the patient denies itching and redness, blepharitis can sometimes present with swelling, especially if it's a more chronic condition. However, the acute onset makes this less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Thyroid eye disease: Although less common, thyroid disorders can cause eyelid swelling. Given the patient's age and the absence of other clear causes, it's essential to consider this, especially if there are any systemic symptoms or a history of thyroid issues.
- Cellulitis or orbital cellulitis: Infection can cause rapid swelling and tenderness. The absence of fever, redness, or discharge makes this less likely, but it's crucial to monitor for worsening symptoms.
- Hypertension-related emergency: Given the patient's history of hypertension (for which she is taking lisinopril-hydrochlorothiazide), it's essential to consider whether the swelling could be related to a hypertensive emergency, although this would typically be accompanied by other symptoms like headache or vision changes.
- Rare diagnoses:
- Wegener's granulomatosis (Granulomatosis with Polyangiitis): A rare autoimmune disorder that can cause a variety of symptoms, including eye swelling. The lack of other systemic symptoms or a history of autoimmune disorders makes this less likely.
- Sjögren's syndrome: An autoimmune disorder that can cause eye symptoms, but typically includes dryness and other systemic symptoms, which this patient does not report.