The differential diagnosis of eyelid
erythema and
edema is broad, ranging from benign, self-limiting
dermatoses to malignant
tumors and vision-threatening
infections. A definitive diagnosis usually can be made on physical examination of the eyelid and a careful evaluation of symptoms and exposures. The finding of a swollen red eyelid often signals
cellulitis.
Orbital cellulitis is a severe
infection presenting with
proptosis and
ophthalmoplegia; it requires hospitalization and intravenous
antibiotics to prevent vision loss. Less serious conditions, such as
contact dermatitis,
atopic dermatitis, and
blepharitis, are more common causes of eyelid
erythema and
edema. These less serious conditions can often be managed with topical
corticosteroids and proper eyelid hygiene. They are differentiated on the basis of such clinical clues as time course, presence or absence of irritative symptoms, scaling, and other skin findings. Discrete lid lesions are also important diagnostic indicators. The finding of vesicles, erosions, or crusting may signal a herpes
infection. Benign, self-limited eyelid nodules such as
hordeola and
chalazia often respond to warm compresses, whereas
malignancies require surgical excision.