Periorbital and Conjunctival Edema

Presentation

The patient is frightened by facial distortion and itching that appeared either spontaneously or up to 24 hours after being bitten by a bug or coming in contact with some irritant. One or both eyes may be involved. The patient may have been rubbing their eyes; however, an allergen or chemical irritant may cause periorbital edema long before a reaction, if any, is evident on the skin of the hand (e.g., occurring in the context of petting an animal then rubbing one’s eyes).

There may be minimal to marked generalized conjunctival swelling (chemosis), giving the sensation of fullness under the eyelid, but there is little injection ( Fig. 22.1 ). In extreme cases, this chemosis may appear as a large, watery bubble (watch-glass chemosis), which may be frightening to the patient but is quite harmless. Tenderness and pain should be minimal or absent, but pruritus may at times be intense. There should be little or no erythema of the skin, no photophobia, no pain with extraocular movements, and no fever. Visual acuity should be normal, there should be no fluorescein uptake over the cornea, and the anterior chamber should be clear.