Unilateral erythematous eyelid edema

Specialty: Ophthalmology.

• unilateral swollen, red and hot eyelid
• unilateral eyelid cellulitis

Why it occurs

• Preseptal cellulitis (eyelid infection anterior to the orbital septum, commonly caused by local skin wounds, insect bites or extension of facial sinusitis)
• Orbital cellulitis (deep retroseptal infection of the orbital tissues, usually due to spread of ethmoid sinusitis)
• Acute suppurative stye with concomitant diffuse inflammatory eyelid reaction
• Acute dacryocystitis with associated eyelid erysipelas
• Allergic reaction due to severe superinfected eyelid contact dermatitis

Initial workup

Rigorous ophthalmological examination quantifying visual acuity, extraocular ocular motility, pupillary reflexes and confrontation campimetry; Computed Tomography (CT) of the orbits and paranasal sinuses with contrast (definitive test of choice to discern between preseptal and orbital cellulitis, and rule out subperiosteal abscesses or intraorbital collections); Complete blood count, C-Reactive Protein (CRP) and blood cultures if there is suspicion of bacteremia or high fever.

Standard management

• Amoxicillin-clavulanic acid — 875/125 mg orally every 8 hours in mild-moderate preseptal cellulitis without systemic involvement
• Ceftriaxone — 1-2 g intravenously every 24 hours associated with Clindamycin 600 mg intravenously every 8 hours in confirmed orbital cellulitis under hospitalization regimen
• Vancomycin (15 mg/kg intravenously every 12 hours if there is a high clinical suspicion of infection by methicillin-resistant Staphylococcus aureus - MRSA).