Jeffrey M. Shaari

Facial edema can have a variety of etiologies. It can represent local pathology or may be indicative of a systemic process. This section will focus on facial swelling and will be broken down into the following four facial regions: periorbital, nasal and perinasal, cheek, and jaw. Etiologies include infectious, inflammatory, neoplastic, traumatic, iatrogenic, and allergic, and some of these categories will overlap.

Periorbital

The periorbital skin has low tissue resistance, making it particularly susceptible to fluid infiltration and subsequent edema. Generally speaking, local processes tend to cause unilateral edema, whereas systemic conditions tend to affect both periorbital regions.

Infectious

Superficial skin infection: Most commonly caused by Streptococcus and Staphylococcus species, this typically causes a preseptal cellulitis with ipsilateral edema, erythema, and tenderness to the eyelids and periorbital skin. Examination of the conjunctiva and globe is usually normal because the infectious process does not usually cross the tough orbital septum. There may be a history of antecedent trauma or an insect bite.

Sinusitis: Ethmoid and maxillary sinus infections may extend beyond the sinuses to cause periorbital edema. This may range from periorbital cellulitis to cavernous sinus thrombosis. With orbital involvement by infection, conjunctival edema, proptosis, ophthalmoplegia, and vision changes may be present. Mucoceles and mucopyoceles of the ethmoid and frontal sinuses can slowly expand to cause periorbital fullness and swelling, often with associated displacement of the globe.

Dacryoadenitis: Inflammation of the lacrimal gland may be caused by viruses or bacteria. This usually causes swelling associated with tenderness centered about the upper lateral lid. Systemic conditions, such as sarcoidosis and Sjögren syndrome, should be considered when the swelling is chronic in nature and pain is absent.

Dacryocystitis: Swelling centered about the medial canthus is typical for inflammation of the lacrimal sac. There is often associated tenderness and erythema, and pressure over the lacrimal sac may express purulence from the lacrimal puncta.

Epstein-Barr virus (EBV) infection: Seen early in the course of EBV infections, transient bilateral upper eyelid edema is rare and is known as the Hogland sign.

Chagas disease