The eyelid may occur one or both sides. It can be asymptomatic or be accompanied by itching or pain. Etiology An eyelid has many causes (s. Some causes of the eyelid). Usually they caused by a disorder of the eyelid, but can also by disturbances in and around the orbit or by systemic diseases that cause grows a generalized edema. The most common causes are allergic in nature and include Local allergy (contact allergy), systemic allergy (z. B. angioedema, systemic allergy, allergic rhinitis accompanying a) A focal swelling of one eyelid is usually caused by a Chalazion. The most dangerous causes are orbital cellulitis and cavernous sinus thrombosis} (rare). In addition to those listed in Some causes of eyelid diseases, eyelid one may have the following reasons emerge: disorders affecting the eyelid, but no swelling cause until they are very advanced (eg, eyelid tumors, including squamous cell carcinoma and melanoma.) Disorders that cause swelling (but not to the lid belonging) begins in structures near the eyelid, and usually there is the heaviest (z. B. dacryocystitis, canaliculitis) extends disorders where swelling occurs, which, however, is not the main symptom ( z. B. skull base fracture, burns, trauma, postoperative swelling) Some causes the eyelid cause suspicious findings Diagnostic approach diseases of the lids Allergic reaction, local itching, no pain he or conjunctiva, or both pale and swollen Sometimes history with recurrences, an allergen exposure, or both Unilateral or bilateral Clinical evaluation blepharitis concern and crusting of the eyelashes tend to be simple or eyelid / enlargement (z. B. with a slit lamp) visible itching, burning, redness, ulceration or a combination thereof Sometimes simultaneous dermatitis Unilateral or bilateral Clinical evaluation Chalazion Focal redness and pain, affecting only one eyelid Ultimately, development of localized, non-painful swelling away Clinical from the lid margin evaluation conjunctivitis, infectious conjunctival injection, discharge Sometimes preauricular nodes, chemosis or both Unilateral or bilateral Clinical evaluation, usually fluorescein staining to exclude herpes simplex keratoconjunctivitis Herpes simplex blepharitis (primary) cluster of blisters on reddened skin, ulceration, severe pain Unilateral Clinical evaluation herpes zoster (shingles) accumulation of vesicles on an erythematous base, ulceration, severe pain Unilateral, the coverage area of ??the V1 nerve Clinical evaluation Hordeolum Focal redness and pains that affect only one eyelid Ultimately, development of a swelling, which is located at the lid margin, sometimes with pustules Clinical review Insect bite itching, redness, sometimes a papule Clinical evaluation incidents in and around the eye socket cavernous sinus thrombosis (rare) headache, proptosis, ophthalmoplegia, ptosis, decreased visual acuity, fever Most first unilateral, then bilateral manifestations of sinusitis or other facial infection immediate CT or MRI orbital proptosis, redness, fever, pain Limited od Sometimes he reduced visual acuity usually unilateral Sometimes manifestations of initial infection (typically sinusitis) go painful extraocular movements ahead of computed tomography or MRI preseptal cellulitis (Periorbitalphlegmone) swelling (but no exophthalmos), redness, sometimes pain, fever going Usually unilateral Normal vision and ocular motility Sometimes manifestations of initial infection (local usually skin infections) ahead of computed tomography or MRI if necessary to avoid an orbital Systemic diseases * Allergies ical reaction, systemically (eg. , Angioedema, rhinitis) Itching Sometimes extraocular allergic manifestations (eg. As urticaria, wheezing, runny nose) Sometimes history with recurrences, allergen exposure, atopy or a combination thereof Usually bilaterally Clinical evaluation Generalized edema Bilateral asymptomatic eyelid and sometimes facial edema, in the usually also edema of dependent parts of the body (eg. as feet, presacral region) usually manifestations of underlying disease (eg. as chronic kidney disease, heart failure, liver failure, preeclampsia) Sometimes the use of an ACE inhibitor testing for heart, liver or kidney disease after clinical statement Hyperthyroidism (Graves’ ophthalmopathy) Eyes staring, delayed closure of the lids, proptosis, limited extraocular movements not painful, except when the cornea is irritated from drying tachycardia, anxiety, weight loss thyroid function tests (TSH, T4) Hypothyroidism painless, bilateral diffuse swelling of the face Dry, scaly skin; brittle hair cold intolerance thyroid function tests (TSH, T4) Swelling by systemic disease is bilateral and not erythematous. T4 = thyroxine, TSH = Thyroid Stimulating Hormone; V1 = ophthalmic coverage area of ??the trigeminal nerve. Assessing medical history questions about the current course of the disease should determine how long the swelling already exists, whether it is unilateral or bilateral, and whether any injury was preceded (including insect bites). Important associated symptoms that can be identified are itching, pain, headaches, changes in vision, fever and eye discharge. The review of organ systems should for symptoms of possible causes were looking for, including runny nose, itching, rashes and wheezing (a systemic allergic reaction), headache, swollen nasal membranes and purulent nasal discharge (sinusitis), toothache (dental infection), dyspnea, orthopnea and paroxysmal nocturnal dyspnea (heart failure), cold intolerance and changes in skin texture (hypothyroidism) and heat intolerance, anxiety and weight loss (hyperthyroidism). The history should include questions about recent eye injuries or operations, known heart, liver, kidney or thyroid disease, as well as allergies and exposure to potential allergens. The drug history should, in particular the use of ACE inhibitors umfassen.Körperliche examination Vital signs should be evaluated for fever and tachycardia. An eye inspection should assess the situation and color of swelling (erythematous or pale), including the determination of whether it exists on a Lid on both eyelids or both eyes, and whether it is pain-sensitive, overheated or both. The examiner should determine whether the finding is an edema of the eyelids, a Protrosion of the eyeball (proptosis) or both. The eye examination should determine in particular the visual acuity and range extraocular movement (full or limited). This examination can be difficult if the swelling is severe, but it is important because such deficits on an orbital or retro-orbital perturbation point rather than a disease of the eyelid; possibly an assistant is required to keep the eyelids open. Conjunctive are examined for injections and vaginal discharge. Any violation of the eyelid or the eye is evaluated using a slit lamp. The general examination should signs of toxicity that may indicate a serious infection and evaluate signs of causative disorder. The facial skin for dryness and dandruff (which can indicate hypothyroidism) and greasy dandruff or other signs of seborrheic dermatitis investigated. The extremities and the presacral area are on edema, suggesting a systemic cause was investigated. If a systemic cause is suspected, edema for further illustration of the Beurteilung.Wanrzeichen The following findings are of particular importance: fever loss of visual acuity Limited extraocular movements Proptosis interpretation of results Some findings help to distinguish between disease categories. The first important distinction is between an inflammation or infection and an allergy or fluid overload. Pain, redness, warmth and tenderness indicate an inflammation or infection. A painless, pale swelling indicates a angioedema. Itching indicates an allergic reaction and the absence of itch indicates a heart or kidney dysfunction out. A swelling that is localized in the absence of other complaints to an eyelid is rarely caused by a dangerous disorder. A massive swelling of eyelids of one or both eyes should raise the suspicion of a serious problem. Signs of inflammation, proptosis, vision loss and impaired extraocular movements suggest an orbital disease (z. B. orbital cellulitis, cavernous sinus thrombosis), Which could push the eyeball forward or the nerves or muscles concerns. Other suspicious and specific findings are discussed in section Some causes of eyelid aufgelistet.Tests In most cases, the diagnosis can be made clinically and no further testing is required. If an orbital or cavernous sinus thrombosis is suspected, diagnosis and treatment should be done as soon as possible. It should be followed by immediate imaging with CT or MRI. If heart, liver, kidney or thyroid dysfunction is suspected, the organ function is evaluated with laboratory tests and imaging procedures that are appropriate for this organ system. Treatment Treatment depends on the underlying disease. For the swelling there is no specific treatment. Summary Proptosis with impaired eyesight or extraocular movements indicates an orbital or cavernous sinus thrombosis, and diagnosis and treatment should be done as soon as possible. Diseases of the Lids should be a differential diagnosis differentiated from orbital and systemic causes of swelling.