3 Alarming cause of Periorbital Edema

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Periorbital edema also known as Periorbital swelling. Swelling around eyes and area around eyes is known as eye orbit and socket .Sometimes refer to as puffy eyes or periorbital puffiness of eyes.People can have periorbital sing or puffiness in one eye or both.

periorbital-edema
Periorbital Edema

Facts that leads periorbital Edema of human being :


1. Supraorbital margin swelling that includes:

A. Dermoid cysts 

B.Neurofibromatosis 


Dermoid cysts :- They are benign congenital choristomas of the orbit which arises from fetal bone suture lines while developing that is most commonly is the frontozygomatic suture. They consist for approximately 1/2 of childhood orbital neoplasms.

They consists of keratinised epithelium and adnexal structures for example sweat glands and hair follicles . They can also leads bony depression and creat dumbbell extension in orbit and for that excision should be done.

They can also  erode the orbital plate of frontal bone to make attached to the dura thus it’s need to do CT before excision planning .


Neurofibromatosis :- They also produce swelling above eye. Their diagnosis is usually conformed by doing an examination of whole  body structures , as there are often multiple lesions present may be.


2. Lids Swelling 


A. Meibomian Cysts / Chalazion 

B. Basal cell carcinoma / rodent ulcer 

C. Other cause of Periorbital edema 


Meibomian Cysts / Chalazion :- These are  most common cause of Periorbital edema found in human.They are a chronic granulomatous inflammation of a meibomian glands that might occurs on either upper or lower lids and can be seen as smooth , painless periorbital swelling . They may be felt by rolling the cyst on the tarsal plate. Differential diagnosis stye/hordeolum , that is an infection of a hair follicle and mostly painful. Stye / hordeolum mostly treated with antibiotics and local heat application.
When persistent meibomian Cysts that not resolve with conservative treatment i.e hot compress then might be incision and curretage from conjunctival surface is required. 

Basal cell carcinoma ( Rodent ulcer ) :- Most common malignant tumor of the eyelids rather than others .They don’t tend to metastasise  but can be locally invasive .They are mostly common on lower lids, that starts as a small pimple and that ulcerates and form rised edges i.e rodent ulcer .

They can be usually exeised easily in early stages. In order to do excision of basal cell carcinoma  there is required histological analysis and need confirmation of grading of the disease situations. 

Mostly intensive lesions that can required highly specified teqniques eg Mohs’ Micrographic surgical excision controlled by frozen section .
Beside these local radiotherapy / cryotherapy can be so used  as recurrence usually more common , more aggressive and more hard to detect .

Other cause of Periorbital edema:- They are less common and include squamous cell carcinoma (SCC) and malignant melanoma , papilloma , sebaceous cysts , molluscum contagiosum ( as when it occurs on lid margin then it might give rise to a mild viral chronic keratoconjunctivitis and thus it should be excised well) ,  keratoacanthoma , cyst of Moll or zeis i.e (sebaceous glands ).

Rabdomyosarcomas and meibomian glands carcinoma are rare lesions thus needed to be treated by radical excision .


3. Lacrimal system swellings 


A. Lacrimal sac mucocoele 

B. Tumors of lacrimal galand 
Lacrimal sac mucocoele :- They may results by the obstructions of the lacrimal duct that is beyond the sac and results  in a fluctuating swelling which bulges out just below medial canthus and can convert to infected that give rise to a painful and tense swelling i.e called acute dacryocystitis. If this is left for long time then instead of getting cure it might change and give rise to a fistula. 


Treatment of it is done by performing a bypass operation that is between the lacrimal sac and the nose i.e dacryocystorhinostomy . There might occur watering in the eye when eversion of lower lid is performed i.e ectropion , that can cause loss of contact between tear film and the lower punctum of from reflex hypersecretion that result of irritation.Such as by inturning lashes in entropion , and those must be differentiate from a mucocoele.


Tumors of lacrimal glands :- Upper lateral aspect of the orbita there present swelling of lacrimal glands and they results to disturbance of smooth and ocular movements and displacement of the globe forwards, downwards, and inwards .


In pathology the tumors called parotid tumors and they may be pleomorphic adenomas with or without malignant changing properties, carcinomas or  mucoepidermod tumors.

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