Swollen eyelids

swollen is a fairly common condition, an expression of excessive accumulation of fluid in the connective tissues around the eyes. On a theoretical level, any inflammatory process that affects the ocular area can manifest itself with an eyelid edema.
There are numerous causes that can cause the disorder, including irritation, infection, trauma or injury to the eyes, and, most commonly, allergic reactions. Swollen eyelids can also be a clinical sign of a more serious condition, such as orbital cellulitis, ocular herpes or Graves' disease. Eyelid edema may be asymptomatic or associated with one or more symptoms; these can occur before, during or after the onset of swelling of the eyelids and around the eyes. If symptoms persist or worsen it is important to see an ophthalmologist for a thorough clinical examination. A swollen eyelid, if not treated properly and quickly, can cause discomfort and visual disturbances.

of the swollen eyelid, it is however advisable to consult a doctor, especially to prevent the situation from recurring or persisting.

In most cases, the swelling, pain and redness of the eyelid are suggestive of an active ocular infection. Sometimes, these manifestations may be accompanied by secretions of pus in one corner of the eye; the swelling may be unilateral or bilateral and affect both the upper and lower eyelids.
The main symptoms associated with swollen eyelids include:

Eye irritation: red eyes, itching and inflammation of the conjunctiva;
Pain, particularly when the swollen eyelids are caused by an infection;
Redness of the eyelid;
Excessive tear production
Ocular burning and sensation of the presence of a foreign body;
Purulent ocular discharge and crusting around the eyes;
Reduced vision (depending on the extent of the swelling)
Dryness and peeling of the eyelids;
Swelling of the face;
Fever;
Loss of eyelashes.

or from systemic diseases that cause generalized edema.

Main causes of eyelid swelling Causes Distinguishing features Diagnostic approach Disorders of the eyelids Local allergic reaction (contact hypersensitivity)

Reactions to allergens that come into contact with the eyelids (cosmetics, powders, pollen, etc.); commonly cause unilateral or bilateral swelling and itching of the eyelids and / or conjunctiva.

Clinical evaluation Blepharitis

Inflammation of the eyelids mainly caused by an "infection;
Common symptoms include painful swollen eyelids, dropping of eyelashes and crusting around the eyes (especially upon awakening), itching, burning, excessive tearing, redness of the eyes, and sensitivity to light;
Sometimes, it can be concomitant with seborrheic dermatitis;
Unilateral or bilateral.

Clinical evaluation Chalazion

Chronic inflammation of the meibomian sebaceous glands at the eyelid level
Unilateral focal pain and redness, with formation of a small solid cyst along the eyelid margin.

Clinical evaluation Infectious conjunctivitis

Conjunctival infection with swollen eyelids, itching, redness and discharge;
Unilateral or bilateral.

Clinical evaluation, usually with fluorescein to rule out Herpes simplex keratoconjunctivitis Herpes simplex type I blepharitis (Ocular herpes)

Clusters of erythematous-based blisters associated with severe pain and ulceration, which may appear on the eyelids, around the eyes and on the forehead. When a blister appears on the nose (Hutchinson's sign) it is an "indication that the Herpes virus is also infecting the anterior surface of the eye;"
Unilateral.

Clinical evaluation (the condition requires prompt medical intervention) Herpes zoster (St. Anthony's fire)

Clusters of erythematous vesicles, ulceration and severe pain;
Unilateral, characteristic distribution on the ophthalmic branch of the trigeminal nerve.

Clinical evaluation Sty

Acute infection of the sebaceous glands with redness and focal pain involving only one eyelid;
Possible swelling localized to the eyelid margin, sometimes with pus secretion.

Clinical evaluation Insect bite

Itching, redness, and sometimes the appearance of a papule.

Clinical evaluation Riots in and around the orbit Cavernous sinus thrombosis (rare)

Headache, proptosis (protrusion of the eyeball), ophthalmoplegia (paralysis of the muscles of the eyeball that prevents movement), ptosis (drooping eyelid), reduced visual acuity and fever;
Usually unilateral at first, then bilateral.

Computed tomography or MRI (the condition requires immediate medical attention) Orbital cellulite

Often presents with severe swelling of the eyelids and the area around the eyes, which appears purplish and painful
Usually, one-sided;
More severe symptoms include proptosis, decreased visual acuity, pain with eye movement and fever.
Sometimes it is preceded by manifestations of the underlying infection (typically sinusitis).

CT or MRI (orbital cellulitis can be very serious and deserves immediate medical attention) Periorbital cellulitis

Unilateral swelling (without proptosis), redness, pain and fever;
Normal vision and ocular motility;
Sometimes, it is preceded by manifestations of the underlying infection (typically local skin infection).

CT or MRI, to rule out orbital cellulitis Systemic disorders * Systemic allergic reaction (angioedema, allergic rhinitis, etc.)

Abrupt onset, following exposure to an allergen for which one is already sensitized;
Itching and swelling of the eyelids, often bilateral;
Other systemic manifestations associated with the hypersensitivity reaction (such as hives, dyspnoea or rhinorrhea).

Clinical evaluation Generalized edema (systemic processes)

Swollen eyelids are not the presenting symptom of the disease;
The onset may occur over weeks or months in the presence of other skin and systemic manifestations of the underlying disease (eg, chronic kidney disease, heart failure, liver failure, preeclampsia);
Asymptomatic bilateral involvement of the eyelids and, sometimes, edema of the face and other parts of the body (for example: limbs);
Sometimes associated with the use of an ACE inhibitor.

Testing for kidney, heart or liver disorders as clinically hypothesized Hyperthyroidism (with Graves' ophthalmopathy)

Proptosis and alteration of extraocular movements;
Tachycardia, anxiety and weight loss.

Thyroid function test (TSH and T4) ** Hypothyroidism

Diffuse, painless and bilateral swelling of the face;
Dry, flaky skin
Cold intolerance.

Thyroid function test (TSH and T4) Tumors

Some tumors can appear on the eyelids, including squamous cell carcinomas and melanoma).

Biopsy * The eyelid edema caused by systemic diseases is bilateral and not erythematous.
** T4 = thyroxine, TSH = thyroid stimulating hormone. or if it is accompanied by other symptoms or diseases. The analysis of symptoms and clinical signs directs the doctor towards possible diagnoses: