Eyelid swelling, eyelid and face edema, eyelid swelling

A thickened eyelid can be painful, itchy and sometimes even dangerous. Often it disturbs cosmetically, sometimes also the look. More about the causes

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Swollen eyelids: blemishes or warning signs?

Not exactly nice, a thick eyelid. And if it itches, flakes, wets or even blinds your eyes, it's also annoying. There can be a lot behind this. There is rarely any danger to the eye, but it is definitely real.

One of the most important questions is whether or not a thick eyelid is caused by inflammation. Other aspects: The swelling can be locally (locally) limited or it can encompass the entire lid, it can be acute or exist over a longer period of time, i.e. chronic. One or both eyes can be affected: on the upper eyelid, lower eyelid or both, on the inside of the corner of the eyelid or on the outside of the eyelid margin. The swollen area may show up as reddening or other changes in the skin, and it may feel soft or hard.

Depending on the cause, neighboring parts of the eye, such as the conjunctiva and cornea, may be involved. This can also lead to a red eye, increased dryness of the eye and impaired vision.

Some eyelid swellings are congenital, such as the blood sponge (capillary hemangioma). Or a so-called mole that rises above the skin level (nevus cell nevus); it doesn't always have to be brown in color.

In order to anticipate the rather rare menetekel, i.e. the harbingers of impending disaster: Dangerous eyelid swellings include those that indicate severe inflammation of the eye or the eye socket. Or that point to another acute event with further swelling, perhaps also with the risk of shock.

This can be due to what is known as angioedema and / or hives, for example.

In pregnant women, eyelid edema is one of the possible signs of a pregnancy-related disease (gestosis) known as preeclampsia.

Occasionally, a swelling of the eyelid turns out to be a malignant tumor. Hailstone, a typical case of chronic inflammation of the eyelid, is much more common.

Briefly on the subject of cosmetic or plastic surgery: Corrective measures accessible eyelid problems such as a "drooping eyelid", incorrectly also called "tear sac" on the lower eyelid (technical term: dermatochalasis), are not the subject of this article. If, for example, there is inflammation and swelling in the slack skin folds on the upper eyelid, then of course it is also a medical problem.

In addition, aesthetic lid surgery by no means ignores an exact inventory of the conditions on the eyelid. Because pathological changes influence both the procedure during the operation and the cosmetic result.

Why can the eyelids swell at all?

The anatomy of the lid promotes swelling. The eyelids are thin, the tissue underneath loose and soft. It contains little fat, but lots of blood and lymph vessels. This also means that a lot of liquid is moved here in a very small space. Narrow because the eyelids contain a plate of connective tissue that is firmly connected to the eye socket in the corner of the eye and acts like a barrier.

As a result, the eyelids swell quickly and significantly as the fluid level rises (edema). The liquid can most likely escape via the bridge of the nose to the eyelid on the other side. That means: instead of one eyelid, there are often two thick, right and left.

Sebum from glands inside the eyelids (meibomian glands) keeps eyelids and eyelashes supple. The fatty secretion reaches the edge of the eyelid and the back of the eyelid. Other sebum glands (Zeis glands) and sweat glands (Moll glands) open between the eyelashes on the edge of the eyelid.

When the eyelid glands become inflamed or clogged, the eyelid swells, especially at the edge. The stye, for example, is one of the most well-known acute inflammations and swellings of the eyelid. More about the most important causes of eyelid swelling in the "Overview" below.

Have an ophthalmologist assess a swollen eye

© Ingram / RYF

Eyelid swellings: when to see a doctor?

It can happen that you wake up with slightly swollen lids. But as soon as the body gets going, the circulation increases, the accumulated fluid flows away and the eyelids become slim again. Maybe it was just too short a night ... Otherwise, try sleeping with your head slightly up for a few days. And: some women occasionally have swelling of the eyelids before menstruation due to hormonal factors. But that doesn't always explain everything.

Therefore, in general, the advice: If you have eyelid swelling that does not go away after a short time, see an ophthalmologist. If necessary, he will refer you to another specialist, such as a dermatologist. In any case, the ophthalmologist is the right contact for additional eye complaints. He is also in demand for any eyelid injury, including significant eyelid swelling from an insect bite.

Tip: Do not scratch the swollen area: pathogens could get inside and cause inflammation (see for example erysipelas below in the "Overview").

By the way: the use of contact lenses promotes inflammation of the lid (rim). Typically, in all of these cases, the inflammation occurs on both eyelids. It is best to seek advice from an ophthalmologist for this problem as well.

If you suspect that an internal disease, such as kidney or liver disease, is responsible for the swollen eyelids, your family doctor may refer you to an internist. In most cases, those affected suffer from further symptoms that point the way, such as pronounced fatigue.

In the event of sudden swelling of the eyelids and acute shortness of breath or attack-like abdominal pain, call the emergency services (emergency number: 112). For patients with hereditary angioedema, drugs for self-injection are also available in acute cases. Those affected should keep one of these in stock at home in a minimum amount for two doses. Nevertheless, the emergency doctor is always an option, whereby the individual emergency plan should apply here (more on this under "Eyelid swelling in internal diseases", section "Angioedema", below).

Overview: causes of eyelid swelling

Inflammatory swelling of the eyelids in skin diseases

The eyelids fall into the border area between ophthalmology and dermatology (specialist knowledge of skin diseases). Inflammatory skin diseases (eczema) can also lead to inflammation of the eyelids (blepharitis).

Eczema is one of the most common skin diseases, has many forms and is not contagious. Eczema includes allergic contact dermatitis, atopic dermatitis (also called atopic eczema, better known to us as neurodermatitis) and seborrheic dermatitis (seborrheic eczema). Skin diseases such as rosacea also favor eyelid and eyelid inflammation.

Symptoms of eczema in general: Typical symptoms of eczema in the acute phase are itching, redness, blisters, nodules, swellings and crust formation. Later the skin thickens superficially, becomes dry and cracked.

Eczema on the eyelid or the edge of the eyelid is particularly uncomfortable. You should always get to the bottom of them in order to alleviate the symptoms, but also so as not to overlook any serious illness.

Symptoms here: The diseased eyelid rims are swollen and reddened, often sticky in the morning. On the edge of the eyelid, in the corner of the eye and between the eyelashes at the base, there are yellowish-sebum-like scales and crusts. The eyes can burn and water. Foreign body sensation, increased sensitivity to light and obstructed vision are further annoying complaints.

The blink of an eye is painful. As a result of the infection, ulcers can also form on the eyelid. The base of the eyelashes can be damaged, eyelashes fall out or twist and rub on the surface of the eye - the connective and cornea.

Last but not least, the inflamed eyelid skin offers parasites such as lice and mites favorable living conditions. The right eyelid care is all the more important (see tips below).

If a skin disease turns out to be the cause of an inflammation of the eyelid or eyelid margin, the ophthalmologist will refer the patient, if he is not yet being treated by a dermatologist, to such an eye doctor. Danger: Stye and hail, the best-known forms of eyelid inflammation (see below), always belong in the hands of the ophthalmologist first.

  • Allergic contact dermatitis: This acute clinical picture is one of the most common causes of inflammatory swelling of the eyelids. It is based on an allergic reaction of the skin. Among the numerous triggers are components of (eye) cosmetics, care products or dyes, substances from work and the environment, in pharmaceuticals such as eye drops, eye ointments, skin patches, or jewelry (piercing). The responsible particles can also get to the eye through the hands.

    Symptoms: The eyelid swellings usually appear on both sides. The appearance with reddening of the eyelids and around the eyes, itching, oozing blisters, later crust and flaking looks very similar to that of atopic dermatitis (see below). The swellings appear as raised, initially "seed-like" redness, which then turn into wheals, similar to hives. In the long run, the skin becomes coarser and keratinized.

    Therapy: The most important step is to identify the trigger and to avoid it from then on. The dermatologist will also check whether short-term topical treatment with cortisone is appropriate. Antihistamines (internal use) relieve itching. In the case of irritable dermatitis (irritation of the skin), cool, damp eye compresses and then application of a moisturizing skin care cream can have a soothing effect. Best to use in the evening on the eyelids (see also 'Care tips' further down).
  • Atopic dermatitis (atopic eczema, neurodermatitis): The development of this chronic skin disease is complex. Triggering factors range from predisposition to allergic reactions to substances in food or the environment, such as "aeroallergens" in the air, to psychological stress factors. Children up to adolescence and young adults are relatively often plagued by the skin disease. Lid problems including chronic swelling occur on both sides. Overall, the symptoms change with the age of those affected.

    Symptoms: The swollen eyelids are red and itchy. The skin is prone to blisters, oozing crusts and cracks. The surface structure can later become coarser.

    - Infants: The head, face and extensor sides of the limbs as well as flexion folds show itchy redness with very dry skin. Scratching leads to skin infections with pustules and yellowish crusts, possibly fever.
    - Small children and adolescents: The disease mainly affects the flexors of the limbs, neck and hands. Itching is the dominant symptom. The affected skin continues to be prone to dryness, thickening and showing a coarse relief.

    - Another possible course: Sometimes an allergic runny nose or asthma shows up. The skin changes, especially the itching, sometimes subside over time. However, the skin still tends to be dry, is sensitive and is thickened in places (Detailed information in the guide "Neurodermatitis (Atopic Dermatitis").
  • Seborrheic dermatitis (seborrheic dermatitis): The causes are probably predisposition, a changed composition of the sebum and yeast fungi (Malassezia furfur) a role.

    Symptoms: A rash with greasy, whitish-yellowish, sometimes itchy flakes of skin forms on the scalp, face, sometimes also in the chest area, around the ears or on the lids. In addition, secretion can accumulate in the eyelid glands. The eyelash roots are often yellowish encrusted. As a result, bacterial inflammation on the edge of the eyelid caused by skin germs, similar to a stye, can occur (Detailed information in the "Seborrheic Eczema" guide).
  • Rosacea, ocular rosacea: This is one of the most common inflammatory skin diseases in adults, in which hereditary factors and immune processes in relation to a so-called hair follicle mite (DemodexInfestation) are involved. The disease occurs in the fourth to fifth decades of life, more often in women than in men.

    Symptoms:The connective tissue located under the surface of the skin and the sebum glands thicken. Due to inflammation, fine veins expand, the skin reddens, nodules and pustules appear, especially in the area of ​​the forehead, cheeks and nose. The differently pronounced, only partially itchy skin symptoms are otherwise often found on the cleavage, sometimes behind the ears, on the head, neck and back. De facto only in men does the nose thicken and become misshapen over time.
    Sometimes rosacea first appears on the lids and remains limited to it for a long time. Signs of the disease are again acne-like rashes, reddening of the eyelid skin and swelling of the eyelids and their surroundings. Often the edges of the eyelids become inflamed (see below), possibly also the conjunctiva. New blood vessels in the cornea and its opacity are a complication of the Ocular rosacea. Here, the ophthalmologist is required as soon as possible, there Visual impairment threatens(Detailed information in the "Rosacea" guide).

Inflammatory swelling of the eyelids caused by pathogens

Bacteria as a trigger

  • Erysipelas (here: facial rose): This is an acute skin infection that is predominantly caused by germs called streptococci. Even the smallest injury can be a gateway. The pathogen spreads through lymph clefts in the skin. Various factors can promote the infection, such as diabetes mellitus, immune deficiency, and older age.

    Symptoms: Symptoms such as malaise, fever, chills and chills appear right from the start. Soon there is severe reddening, swelling and burning pain in the diseased facial area or lid. Because lymphatic pathways are involved, nearby lymph nodes also swell.
    Important: Medical treatment of this acute skin infection is urgently required - not least because various, sometimes dangerous, complications are possible. The inflamed lymph clefts in the eyelid can become deserted, which can lead to chronic eyelid edema. The optic nerve may be attacked with the risk of going blind.

    It is also possible that the bacteria can spread into the brain, which can lead to a life-threatening clinical picture called cerebral vein or sinus vein thrombosis. Via the bloodstream, the pathogens can also cause inflammation in the heart or kidneys (detailed information in the guide "Erysipelas").
  • Lid abscess, lid phlegmon: A lid abscess is the complication of a lid infection, mostly with germs such as staphylococci (see below: stye) or streptococci (see above: erysipelas). In the case of an abscess, a kind of capsule forms, it can also break through to the outside.

    A phlegmon, on the other hand, spreads flat in the deeper layers of the skin. Lid phlegmon occurs in the rare cases where a bacterial inflammation in the vicinity of the eye, such as a sinus infection, spreads directly to the eyelid. If a phlegmon melts in purulent form, an abscess is created again (emergencies!).

    Symptoms: Both inflammations, which usually occur in one eye, lead to considerable reddening, eyelid and facial swelling (the lid of the other eye can also be swollen!), Overheating of the skin and pain. The lid often cannot be actively opened. The eye seems to protrude slightly because of the swelling of the eyelids, but it can be moved normally. Fever occurs. In the case of an abscess, a so-called soft "fluctuation", a type of sloshing, can be palpable.

    Therapy: As a rule, initially care in the eye clinic; Warm, moist compresses on the lid, and antibiotics, which are effective against staphylococci and streptococci, via the bloodstream. An abscess is opened and drained. After analyzing the germs from the abscess, the doctor adjusts the antibiotic therapy if necessary.
  • Very rare: Phlegmon of the eye socket (orbit): This dramatic but rare clinical picture is caused by a transmitted infection. Usually this spreads from an inflamed paranasal sinus to the eye socket. Paranasal sinuses are air-filled, mucous membrane-lined spaces in the here thin facial bones that are connected to the nasal cavity. Lid and orbital phlegmon are mainly found in young children.

    Up to this age, practically only the already formed ethmoid cells are relevant as a starting point, after that other paranasal sinuses, such as the maxillary sinuses. The ethmoid cells are located in the facial bone between the root of the nose and the inner corner of the eye. A budding phlegmon of the eye socket quickly develops into a dramatic emergency.

    Thanks to the now mostly timely treatment of bacterial infections of the upper respiratory tract, complications such as phlegmon in the immediate vicinity are rare. The recommended vaccination against the hemophilus influenza b (Hib) germ also contributes to this, preventing Hib respiratory infections and possible complications, which are particularly life-threatening for small children.

    Symptoms: The affected eye is very painful and can hardly be moved, it stands out clearly, the entire area around the eye including the eyelids is severely swollen, the conjunctiva is glassy, ​​thickened and reddened. There are also visual disturbances. The children have a fever and look very sick.

    Diagnosis and therapy: Emergency room at the eye clinic. Among other things, an imaging process, such as magnetic resonance imaging (MRT), is used there to examine the eye socket and the site of the inflammation, such as the ethmoid cells. This is immediately followed by an intensive administration of antibiotics via the bloodstream, possibly also an operation.

Stye: A sebum gland on the lid becomes inflamed

© W & B / Jörg Neisel

  • Stye: This is due to an acute bacterial inflammation of the meibomian glands in the eyelid or the sebum glands directly on the edge of the eyelid. Germs called staphylococci are responsible. If a stye occurs repeatedly, one (type 1 diabetes mellitus, type 2 diabetes mellitus) should be excluded.

    Symptoms: A stye is found on both the upper and lower eyelids. Not only does the inflamed area, which is very painful and clearly reddened, often also develop a pus, but the entire lid can be swollen. Possible complications: purulent melting of the lid skin (abscess, demarcated or encapsulated) or an area melting inflammation (phlegmon of the lid, see above in each case) (Detailed information in the guide "(Hordeolum)").

Care tips for the eyelids

Apply warm, moist compresses to the closed eyelids for several minutes. As a result, tough gland secretions can liquefy and squeeze out more easily through careful massage towards the eyelashes. Proceed very hygienically. In many cases, it is recommended to carefully loosen the scales and clean the edge of the eyelid using a cotton swab soaked in lukewarm water, paraffin oil or olive oil.

Olive oil appears to have anti-inflammatory effects. It is possible that components such as vitamin E and monounsaturated fatty acids stabilize the skin's "barrier function". Use the cotton swab only once per application site.

External environmental factors - stimuli such as dry air, smoke or dust - or a dry eye also promote inflammation of the lid (rim). Smoking is not only harmful to the eyes, it is generally known to be harmful to health.

Therefore, it is always worth trying to quit smoking. The room air should be pleasantly humidified, the living and working rooms should be kept dust-free, and protective measures should be implemented at the workplace. It is essential to have dry eyes examined and treated by an ophthalmologist.

Viruses as a trigger

  • Herpes simplex: Herpes simplex viruses thrive on mucous membranes. Cold sores (cold sores) are among the most common infections with herpes viruses and are mainly caused by the herpes type HSV-1. The first contact takes place very early in life, namely as a cared for and caressing baby.

    The infection either goes unnoticed or manifests itself as a painful and febrile infection in the mouth (aphthous ulcers, herpetic gingivostomatitis, oral rot). The less common herpes infection on the eyelid - herpes simplex blepharitis or blepharoconjunctivitis, if the conjunctiva is also affected - often takes place as part of an initial infection with HSV-1 and therefore mostly in childhood.

    Through hand contact with the highly infectious vesicles, the viruses can get into the area around the eye and cause inflammatory vesicles there as well.

    Like all herpes viruses, herpes simplex survives in the body (latency): The virus nests in nerve cell nodes (sensitive ganglia) near the spinal cord or the cranial cavity. In the event of stress, exposure to the sun, a changed hormonal level or a weakening of the immune system, it can become active again and migrates back along the nerve to the original "crime scene". In the case of the eyes, the cornea in particular is affected (dreaded herpes corneal inflammation = herpes keratitis).

    Symptoms of the eyelid (and conjunctiva) initial infection: Fluid-filled vesicles appear on the slightly swollen edge of the eyelid. Often the conjunctiva is also red and swollen. Lymph nodes nearby in front of the ear can temporarily swell.

    A virus-inhibiting drug (antiviral) is often indicated in these cases. But be careful: In the case of eyelid swelling and herpes, always go to the ophthalmologist go (detailed information for example in the guide "Herpes labialis (cold sores)"). He will tailor the treatment to the severity of the infection.
  • Herpes zoster on the face: The disease, also known as facial rose, is caused by the chickenpox virus (varicella zoster virus). Herpes zoster is a skin and nerve disease.

    The first infection usually takes place as a "childhood disease chickenpox". After that, those affected are protected against re-infection. However, the immune system cannot prevent the same virus from becoming active again at a later time.

    Because herpes zoster viruses also survive in the body ("latency", see above, herpes simplex viruses). The pathogen can become active again after many years due to favorable factors, such as a weak immune system. This usually only happens once in healthy adults.

    A person who is not immune to chickenpox can get chickenpox if they come into direct contact with the contents of the vesicles and ingests the virus. The "rose" itself, however, only ever arises through activation of the chickenpox viruses acquired earlier. So it is not a new infection.

    Symptoms: There is itching, burning or pain in the supply area (dermatome) of the affected cranial nerve - the trigeminal or triple nerve - on one side of the face. If the first branch area is affected, the symptoms mainly appear on the forehead and adjacent scalp, on the upper eyelid, on the eyebrows and on the nostrils.

    In the case of the second branch area, the unpleasant sensations are concentrated in the area between the lower eyelid and lips, that is, on the cheek and the upper lip.

    Usually two to three days after the onset of pain, grouped nodules appear on the reddened skin, which quickly turn into clear blisters. The highly infectious contents then turn yellowish, and finally the vesicles dry out and become encrusted within seven to ten days. As long as there are bubbles, there is a risk of infection.

    In the course of the herpes zoster, sometimes even before, general symptoms such as tiredness, tingling, fatigue and fever appear. In addition, there may be pain in certain areas of the body in advance, such as the neck.

    The Zoster infection of the eyelid can spread to the cornea and iris (zoster ophthalmicus) and endanger eyesight if it is not treated in time. If there is still pain in the affected area one month after the skin symptoms have subsidednen Doctors speak of postherpetic neuralgia. The pain can sometimes last for a long time, even for several years.

    Therapy: In the case of zoster in the face or head area (nose, eyes, ear), always see a doctor! An early onset of virostatic therapy (infusion) is always necessary for herpes zoster on the face because of the risk of further complications. It can accelerate healing and reduce the risk of zoster neuralgia (detailed information in the "Herpes zoster" guide). The doctor will also recommend agents for local treatment of the blisters on the face, such as a colorless, transparent zinc gel, and later an ointment to soften the crusts.
  • Dell warts (Mollusca contagiosa): They are caused by so-called human papilloma viruses (HPV). In children, dellar warts often occur in the eyelid area, on the neck, arms and hands.

    Symptoms: Millimeter-sized, whitish, painless nodules with a central dent are formed. The nodules are very contagious, the viruses are easily passed on through direct skin contact or a smear infection, for example infected objects such as clothing or towels. Concomitant conjunctivitis can occur in the eye (detailed information in the guide "Dellwarzen").

Hailstone: The slightly different eyelid inflammation

  • If the exits of sebum glands in the eyelid (meibomian glands) or on the edge of the eyelid (Zeis glands) are chronically blocked, the secretion builds up and the surrounding tissue becomes inflamed. Result: a hard structure on the lid, aka hailstone. This time, however, no pathogens are directly triggering. Doctors speak of granulomatous inflammation here, because under the influence of certain inflammatory cells, nodular cell clusters form in the tissue.

    There are various requirements, including metabolic diseases such as diabetes mellitus or a stye! (see above). A sebum gland carcinoma of the meibomian glands is seldom hidden behind a supposed hailstone. An equally malignant eyelid tumor such as basal cell carcinoma (see below) can look similar to a hailstone.

    Symptoms: There is usually a painless, coarse lump the size of a grape or cherry stone on the lid, which cannot be moved with gentle finger pressure. The diseased area may also be red and swollen.

    Diagnosis and therapy: Small hailstones can partially regress on their own. Otherwise to be on the safe side, quickly to the doctor with it. The ophthalmologist is primarily responsible, if necessary in close consultation with a dermatologist or the family doctor.

    In most cases, the doctor will immediately give the all-clear, as well as tips on local treatment measures such as anti-inflammatory eye products, red light, moist, warm compresses on the closed lids. If a hailstone is too big or conservative measures do not help, it is surgically removed while protecting the edge of the eyelid.

    The doctor will take into account special causes such as other eye or underlying diseases in the therapy (detailed information in the guide "Hagelkorn (Chalazion)").

Eye, tears & Co.

© W & B / Ulrike Möhle

Inflammation of the lacrimal gland, tear ducts and more ... altered tear fluid, tear duct obstruction in infants

A little anatomy in advance: The large lacrimal gland is partly on the side above the eye socket, partly in the upper eyelid. The tears flow into the lateral upper conjunctival sac - the envelope fold of the conjunctiva under the upper eyelid. There are other lacrimal glands there.

The blink of an eye distributes the tear fluid on the cornea. They are rinsed up to the inner corner of the eyelid, where they flow through the teardrop points on the upper and lower eyelids and the draining tubules into the tear sac (here the name is correct!). It lies inside under the nostril. From there to the nose there are only a few millimeters for the tears.

  • Lacrimal gland inflammation: dacryoadenitis is the inflammation of the lacrimal gland. It occurs far less often than an inflammation of the lacrimal sac (see below) and usually on one side. There are acute and chronic forms. Acute inflammation occurs primarily in the context of certain viral infections such as mumps, flu or infectious mononucleosis (Pfeiffer's disease).

    Sometimes bacteria are also the triggers, such as streptococci and staphylococci, which can rarely set off an abscess. Chronic lacrimal inflammation is based, for example, on specific infections, such as tuberculosis, on diseases such as sarcoidosis or leukemia, and sometimes on certain types of lymph node cancer.

    Symptoms:
    - Acute: The upper eyelid is swollen on the temple side and, with moderate swelling, only goes deeper in this area, which is why doctors in this case use the "Paragraph form"Speak. It is spontaneous and painful and also reddened with gentle pressure.
    - Chronic: The swelling of the lacrimal gland develops slowly, is painless and affects one or both eyes. The eyeball is usually shifted inwards and downwards, which can simulate a pathological change in the eye socket.
    - Chronic special forms: In addition to painless, chronic swelling of both lacrimal glands, the parotid glands can also swell in some patients - symptoms such as those in one Sjogren's syndrome to be watched (detailed information in the guide 'Sjogren's syndrome'). Pronounced dry mouth is also one of the key symptoms here.

    Independent causes of Sjogren's syndrome - then it is called secondary Sjogren's syndrome - are, for example, blood diseases such as chronic lymphocytic leukemia, Hodgkin's lymphoma or sarcoid. The latter, in turn, is a systemic disease that affects several organs (detailed information in the guide "Sarcoid (Boeck's disease)").

    The combination of chronic lacrimal inflammation, uveitis in both eyes - uveitis affects the middle parts of the eye, including the iris -, salivary gland inflammation on both sides and facial paralysis the Heerfordt Syndrome. Here too, sarcoid can be the cause.

    Diagnosis: The ophthalmologist recognizes a swollen lacrimal gland conditionally when examining the eye. Further measures, which are aimed either at the eye itself or at the detection of a general illness, depend on the respective suspected diagnosis.

    Therapy of lacrimal inflammation in general: In the case of acute inflammation as part of a viral infection, moist, warm compresses and anti-inflammatory agents can be helpful. If you have a bacterial infection, your doctor will use antibiotics. Otherwise, the therapy depends on the possible underlying disease (see text links).
  • Inflammation of the tear sacs: A congestion in the tear sac means germs. As a result, the tear sac or duct becomes acutely inflamed (dacryocystitis). The clinical picture tends to occur more frequently in old age.

    Symptoms: The area around the eye sack (which is not the same as a slack, fat-padded lower eyelid!) Below the celiac ligament - the small fold visible in the corner of the eye - is painfully swollen and reddened. Pus can penetrate into the eye, which can also be reddened.

    When the surrounding tissue becomes inflamed (dacryophlegmon), the eyelids swell too, possibly even on the opposite side. In the further course, an abscess is also possible, but this can usually be avoided with timely treatment.

    Therapy: The inflammation can often be cured with antibiotics and disinfecting moist compresses. In the case of severe inflammation and swelling, especially phlegmon, a small dissipative incision must be made in addition to the high-dose antibiotic therapy in order to relieve the tear sac. If there is an abscess, the ophthalmologist will open it and ensure that the pus is adequately drained.

    After the inflammation subsides, the tear sac generally remains closed. In order to avoid renewed inflammation, tear drainage must be restored. Various techniques are available for this: endoscopic, opening with a micro-drill or laser (laser sacryoplasty), sometimes also by an operative intervention from the inside (from the nasal cavity) or from the outside (toti operation). Depending on the procedure, an ENT doctor will be involved in the procedure.
  • Tearway obstruction in infants: Normally, the nasal passage, the normal drainage route for tears, becomes open by itself after the baby is born. Sometimes, however, it remains closed by a membrane (congenital tear duct stenosis).

    Then secretions build up in the area in the first few weeks of life, tears and pus appear in the swollen corner of the eyelid, the surrounding skin is somewhat reddened. In the worst case, an inflammation of the lacrimal sac with an abscess or inflammation of the surrounding tissue (phlegmon; see above) can develop.

    Therapy: The doctor will first try to break the skin by applying light pressure to the corner of the teardrop. He will show the parents how they can perform the gentle but deliberate stroking movements towards the baby's nose several times a day. In addition, the doctor can prescribe certain eye drops. If all of this is unsuccessful, he will try to flush the tear duct through an inserted tube. If that doesn't help either, he opens it up with a fine probe.

    The pediatrician and ophthalmologist advise the parents concerned about the right time and the type of intervention. In general, the recommendation is not to wait too long to see whether the canal opens, because repeated inflammation can lead to sticking.

Non-inflammatory eyelid swellings: Lid tumors

The term tumor actually means swelling of a tissue or part of an organ. It says nothing about whether it is a benign or malignant change or a tumor. Nevertheless, it is now often used synonymously with cancer. There are numerous types of tumor on the eyelid - benign and malignant.

Benign tumors on the lid

  • Xanthelasma: Yellowish, rather flat, fatty deposits (plaque) on the inner corner of the eyelid, upper eyelid or lower eyelid; partial expression of a certain lipid metabolism disorder (familial hypercholesterolemia, which the family doctor can clarify on the basis of a blood test (important for the prevention of possible cardiovascular diseases!).

    Therapy: Removal by laser surgery or by surgery, which means that a cosmetically satisfactory eyelid tightening is also possible.
  • Neurofibroma: This benign tumor starts from the connective tissue of cutaneous nerves. Neurofibromas occur sporadically and individually or in large numbers in von Recklinghausen's neurofibromatosis (here: type 1). Neurofibromatosis is an inherited tumor disease and the most common genetic disease with an autosomal dominant inheritance (autosomal refers to all genes in the body outside of the sex chromosomes).

    This means that the inherited mutation of the corresponding NF-1 gene always leads to the disease, even if it can develop very differently.

    To the main symptoms include the neurofibromas. These stalked skin tumors, which lie both in and under the skin, can spread over entire parts of the body - an enormous psychological burden for those affected. A variant The so-called plexiform neurofibromas can become quite large and are often found on the face including the eyelids, among other things. If such a structure weighs down on the upper eyelid, it sinks and hinders vision. The tumors increase with age.

    In the eye itself, new tissue formations occur in this disease: so-called Lisch nodules in the iris (iris nodules), tumors on the optic nerve or in the retina, as well as neurofibromas in the eye socket. People can also develop skeletal changes or neurological disorders. In addition, with neurofibromatosis there is an increased risk of certain cancers.
  • Seborrheic hyperkeratosis: wart-like, superficial swelling of the eyelid, mostly in old age, promoted by exposure to sunlight.

    Symptoms: Often stalked, flat structure with a scaly surface and brownish color.
  • Keratoacanthoma: The central keratinizing skin tumor grows very quickly. Since it resembles a basal cell carcinoma (see below), it usually has to be removed and the tissue examined in detail, unless it resolves on its own.
  • Cyst (retention cyst): A cyst is a mostly encapsulated, sac-shaped cavity with different contents in the tissue. For example, cysts of the sweat glands located under the skin occur on the eyelids, especially the edges of the eyelids.

    As these structures can interfere with the functions of the eyelid, it is usually advisable to remove them.

    Therapy in each case: The removal of the swelling or lump has already been mentioned in some cases and is carried out using a laser or different cutting techniques that are as careful and economical as possible. This is done in such a way that ideally neither a scar nor a shifting of the eyelid arises. The tissue removed is examined in fine tissue.

    This is especially true for suspicious changes. In these cases it will no Laser used as it would destroy the tissue. In the case of von Recklinghausen's neurofibromatosis, limited interventions on the lid for functional and aesthetic correction are indicated. The tumors cannot be completely removed. For this they are too much anchored in the tissue or simply outnumbered. Regular medical checks are recommended, depending on the clinical picture.

Malignant tumors on the lid

  • Lymphoma (malignant): These are certain forms of lymph gland cancer with more or less pronounced malignancy. Lymphoma sometimes starts as eyelid swelling and can cause the eyelid to open hangs down. If the eye socket is (also) affected, a changed position and restricted mobility of the eyeball can result. As a result, pain and double vision are possible.

    A sample (biopsy) provides information about the type of tissue. A specialist in internal medicine or cancer medicine (internal oncology / hematology) takes on the further diagnosis and treatment.
  • Lacrimal gland tumors: Lymphomas also rarely occur in the lacrimal gland. Cyst-like forms of cancer originating from the glandular tissue, so-called adenoid-cystic carcinomas, which initially grow rather slowly are also rarely found there.
  • Basal cell carcinoma (basalioma): This most common malignant eyelid tumor occurs in a variety of forms, mostly on the lower eyelid. For the most part, the tumor does not form metastases, but it can grow and destroy the surrounding area, right down to the bone. At the inner corner of the eyelid, for example, these tumors can quickly penetrate the lacrimal sac and sinuses.

    Symptoms: Lump with a raised edge and a small crater in the middle, often bleeding there too. The rest of the surface appears shiny, shows a fine pattern of vessels, is sometimes also brownish in color. Some basaliomas grow on the outside rather flat and deep.

    Therapy: Complete surgical removal, if possible with healthy tissue margin (microscopically controlled surgery). Cosmetically unfavorable tissue defects can be covered with the help of plastic-surgical measures. In addition, there are various treatment alternatives that are also adapted to the age of the patient, such as cold sclerotherapy (cryotherapy), photodynamic therapy and local treatments with certain substances.

    In the first three years after the therapy, an annual check-up should take place at the dermatologist (detailed information in the guide "Basalioma (light skin cancer)").
  • Squamous cell carcinoma (spinalioma): Flat or raised swelling with an "uneven" surface (cornification, ulcer or crust formation). Risk factors: long-term exposure to sunlight, old age. Actinic keratosis is the precursor. Here the malignant cells are still limited to the epidermis.

    Therapy: After confirming the diagnosis with a dermatoscope (magnifying glass with the aid of a light source) and examining a tissue sample, the tumor is surgically removed if possible. In advanced stages, chemotherapy or immunotherapy are possible.

    Numerous procedures are available for the therapy of the preliminary stage (actinic keratosis) (detailed information in the guide "Actinic keratosis (solar keratosis, actinic precancer)" and in the guide "Squamous cell carcinoma (spinalioma, light skin cancer").
  • Malignant melanoma: Black skin cancer on the eyelid is rare. A dark (pigmented) discoloration ("birthmark") or a complexion to flesh-colored skin mark is always in need of clarification (detailed information in the guide "Malignant Melanoma (Black Skin Cancer)").

    Therapy: As a rule, it follows the treatment guidelines (see brief guideline for malignant melanoma, Dermatological Oncology Working Group (ADO), under "Specialist literature" at the end of the article).

! Caution: A swelling of the eyelid (edge) that resembles a hailstone (more on this above, section "Hailstone, the somewhat different eyelid inflammation") may hide a malignant swelling, although this is rare overall.

To be on the safe side, always go to the ophthalmologist with it, even if the structure does not cause any major problems.

Eyelid swelling in internal diseases

Skin swellings (edema) are accumulations of water and salt in the intercellular tissue. This can be caused by leaks in the smallest of vessels, increased pressure in veins, impaired lymph drainage or pronounced protein deficiency. This in turn is based on various diseases or disorders. Edema can occur locally, for example on the lids, all over the face, on the shins or ankles.

With systemic diseases, both eyelids are usually swollen and other symptoms appear. Internal organs can also swell. Often there are serious clinical pictures or other types of organ damage. In addition to eyelid edema, the diseases or disorders mentioned below are associated with other, more or less characteristic complaints.

  • Melkersson-Rosenthal syndrome: Melkersson-Rosenthal syndrome can sometimes occur in connection with Crohn's disease - a chronic inflammatory bowel disease - or with sarcoid.

    Symptoms are an intensely furrowed tongue (lingua plicata), attack-like swellings of the lips due to enlarged lip salivary glands and the face, including the lids, cheeks or forehead. Itching is absent. The technical term orofacial granulomatosis describes a type of inflammation that is partially underlying here.

    Sometimes paralysis of the facial nerve on one or both sides also occurs when it swells at the point of passage through the skull bone. The clinical picture often resolves spontaneously, but can recur. The facial paralysis or disorders of other cranial nerves can be present or persist in different ways in the further course.

    Therapy requires an accurate diagnosis. Comprehensive examinations, including fine-tissue analyzes of tissue samples taken (from the intestine, from swollen tissue in the facial area) may be necessary for this.

    Doctors use various drugs without any reliable study results being available. This is due to the rarity of the clinical picture. In individual cases, taking or injecting cortisone into swollen areas can be helpful.
  • Graves' disease of the thyroid / endocrine orbitopathy: This is an autoimmune hyperfunction of the thyroid, with and without goiter. The hyperfunction is caused by the body's own immune substances (autoantibodies) against the starting point of a central hormone in the thyroid's control system, the TSH receptor.

    The hormone TSH from the pituitary gland normally uses this starting point to stimulate the thyroid gland to produce hormones. The pathologically formed autoantibodies do the same.

    Important symptoms This thyroid disease affects the eyes in particular (this is what the name orbitopathy includes; endocrine refers to the hormonal disorder: swelling around the eyes, including the eyelids and the connective tissue of the eye socket). The eyeballs protrude (exophthalmos), the conjunctiva can become inflamed. Pasty swellings are rarely seen on the shins, the so-called myxedema (Detailed information in the guide "Basedow's disease (Basedow's disease")).
  • Underactive thyroid (hypothyroidism): Pronounced hypothyroidism can also lead to swelling of the connective tissue under the skin on the arms, legs and face including the eyelids - i.e. to eyelid edema. The skin looks thickened and swollen, it is dry and cool. Various mental and physical functions are slowed down with an underactive thyroid (Detailed information in the guide "Hypothyroidism").
  • Nephrotic syndrome: In this disorder, which can occur in the course of inflammatory kidney disease (glomerulonephritis), there is a pronounced loss of protein via the kidneys. Kidney corpuscles, the delicate blood vessels (glomerula) in the kidney cortex, filter the blood and form the first stage of the urine. Infections, pathological immune processes, metabolic disorders such as diabetes, but also some drugs can damage the kidney corpuscles.

    Then the fine vessels become increasingly permeable for substances that they normally hold back. This mainly affects large blood proteins such as albumin. It binds water and thus ensures a balanced distribution of fluids in the tissue. If it is lost through the kidneys, it is missing from the blood (hypoalbuminemia). As a result, edema forms.

    Symptoms: Severe protein loss through the kidneys (proteinuria of more than 3.5 grams per day) leads to extensive swellings in the connective tissue under the skin. The edema that can be pressed in with the finger appears, depending on the body position, on the lower legs, in the lower back or on the flanks. The fingers and eyelids are also often swollen, especially in the morning.

    In addition, ascites can lead to an increase in the size of the abdomen.If fluid collects between the chest and lungs (not to be confused with "lung water" in the case of heart failure), breathing is difficult (Detailed information in the guide "Kidney inflammation (interstitial nephritis, glomerulonephritis)").
  • Too little sodium (a blood salt) or a lack of protein in other serious illnesses also promote edema. This can be, for example, advanced liver cirrhosis. This leads to a disruption of protein formation and redistribution of body fluids.

    Pronounced malnutrition, for example in the case of severe intestinal diseases, then burns and clinical pictures such as ARDS (Adult Respiratory Disstress Syndrome) are further possible causes.
  • Angioedema: Not Allergic - Right? Angioedema describes the pathological circumstance that blood vessels in the depths of the skin suddenly become permeable. As if through a filter, large amounts of fluid leak from the blood into the environment. Various triggering factors can play a role here - including medication.

    Bradykinin is also involved in angioedema attacks that are triggered by various "stimuli": cardiac drugs such as ACE inhibitors and AT1 receptor antagonists (sartans), physical factors such as cold or vibration, infections, surgical interventions in the mouth and teeth, hormonal changes, Use of medicines containing estrogen. Bradykinin is probably also involved in angioedema of unknown origin. Often there is no specific trigger for angioedema.

    The risk of confusion with allergies is always great, but these are the forms of angioedema mentioned not allergic conditionally. Therefore, drugs such as antihistamines and cortisone are of little use here. If triggering stimuli are known, they should of course be avoided as far as possible. If the diagnosis is known, a drug such as C1-INH concentrate can be used as a short-term prophylaxis before a critical procedure in the oropharynx.

    Symptoms: Under the influence of a certain endogenous substance called bradykinin, an unpredictable and repeated, violent skin reaction occurs with often monstrous swelling of the eyelids and face, especially the lips. The swollen facial skin is tense, pale, possibly slightly painful, but does not itch. The skin is also not red and does not show any wheals, different from, for example, urticaria (see below). The edema recedes after a few days. In the case of attacks, which occur at monthly or even weekly intervals, in any case completely unpredictable, severe abdominal pain is also possible if the intestinal wall swells up.

    These extremely painful abdominal attacks can also (years) precede the edema attacks. Even the hands, feet, urinary tract and genitals sometimes swell. Dangerous courses of angioedema cannot be ruled out, for example if the tongue and larynx also react or a significant loss of fluid through the intestine sets in. The vocal cords in the larynx form the glottis. If the tongue swells or the glottis closes (glottic edema), considerable shortness of breath occurs and there is a risk of death from suffocation. Warning symptoms: tightness in the throat, changed voice, shortness of breath.

    Bradykinin-mediated angioedema can, more rarely, also be hereditary. They are then called hereditary angioedema (HAE). There are changes (mutations) of various genes, mostly associated with a disorder and / or deficiency of a certain protein (C1 esterase inhibitor, or C1-INH for short). This enzyme is active in body systems where bradykinin plays a key role. For diagnosis and therapy planning, the specialist is required, who carries out the necessary steps up to blood analyzes and recommended genetic tests.

    ! Important: Various medications are available for treatment (acute or long-term treatment). Self-treatment at home, accompanied by a doctor, is also possible. Every patient with HAE due to C1-INH deficiency should be provided with an emergency ID card and emergency medication. Affected patients, including pregnant women, are best looked after at an HAE treatment center in consultation with relatives and the family doctor / gynecologist. The drug treatment for hereditary C1-INH deficiency is usually a long-term therapy. A patient self-help group provides information to those interested (see "Specialist literature / Further information" at the end of the article).
  • The situation is different with swellings in hives (urticaria). This is associated with severe itching and only affects the superficial layers of the skin and not the mucous membranes. Usually it is a so-called mast cell-mediated reaction. Certain antibodies produced in the body called immunoglobulins E (IgE) cause the mast cells to release the tissue hormone histamine - a typical allergic reaction. Classic triggers (allergens) are, for example, foods such as crustaceans, fish, nuts or peanuts. Natural latex also plays a role. Insect venom also has a strong allergy potential.
  • Histamine is also involved in swelling caused by hypersensitivity reactions, and urticaria is again common. The triggers, food coloring or medication, quickly lead to the release of histamine from their stores, the mast cells.

    In extreme cases, an allergic or hypersensitivity reaction with urticaria can turn into an allergic shock (anaphylaxis, emergency). This means: In the case of an acute allergic reaction, the eyelids and other parts of the face, especially the lips, mouth and tongue, can initially swell. The further course can lead to symptoms such as dizziness, headaches and skin reactions (reddening, itching, wheals), followed by severe shortness of breath, drop in blood pressure and life-threatening respiratory and circulatory arrest.
  • A pseudo-allergic reaction with edema is not mediated by IgE antibodies. Possible triggers such as acetylsalicylic acid, so-called non-steroidal anti-inflammatory drugs (anti-inflammatory NSAIDs; exception: COX-2 inhibitors) and contrast media injected into the blood can call up special vascular-active substances via a direct pharmacological effect, and "vascular leaks" and edema occur again. However, a contrast medium reaction can also run via the histamine lever.
  • An autoimmune mast cell or histamine reaction or an autoimmune dysfunction of C1-INH (see above) is rare, for example in certain forms of lymph node cancer, autoimmune diseases or infectious diseases. Then treating the underlying condition will help prevent angioedema attacks.

    How else can you prevent angioedema, urticaria or anaphylaxis?

    In the case of swelling, all forms are possible - from mild to life-threatening. If the cause of angioedema, such as a drug such as an ACE inhibitor, is known, the motto is to avoid it immediately. If the cause is unknown, this is of course (initially) difficult, the course unpredictable, but immediate emergency care with all currently available measures is often life-saving. This also applies to severe allergies. Long-term preventive therapy is possible for hereditary angioedema. It is always crucial that an exact diagnosis has been made in the meantime.

    If it is again certain that a drug was responsible for a pseudo-allergic reaction, the emergency doctor, clinician or family doctor will also check, suspend or change the therapy depending on the symptoms that have occurred.

    Anyone who has already suffered a severe reaction from an insect venom allergy should always have their emergency kit with them, with prepared adrenaline injections for self-injection. The set also contains other antiallergic drugs such as cortisone, an antihistamine and an inhalable beta sympathomimetic. In an emergency, however, always consult a doctor or emergency physician.

    Check the shelf life of the emergency equipment once a year and replace it if necessary. Immunotherapy, formerly known as desensitization, is basically possible for various allergies, including those to insect venom (see also advice on "hay fever, allergic rhinitis"). Before the treatment, the doctor will inform you exactly about the possible risks.

    Training courses on how to use the emergency kit are very important. Allergy sufferers, especially if they are at risk of anaphylaxis, receive an allergy pass. Patients with hereditary angioedema are also provided with an emergency card / emergency medication (see above). Those affected should take the equipment with them wherever they go.
    Further information on the subject of urticaria can be found in the corresponding guide "Urticaria (hives)".
  • Unilateral edema in the eyelid and face area: Unilateral eyelid swelling is rare in a disease that does not affect the eye itself, apart from insect bites. A possible cause can be damage to the central nervous system, in which the nerve pathways for the vascular motor function (vasomotion) are also affected on one side of the head. Facial paralysis (facial paralysis) can have an unfavorable effect on the venous drainage and thus also lead to local swellings.

    The vein drainage from the head area may be a little deeper, for example in the neck region, and lead to swelling on the corresponding side of the face. This also affects the neck, there is a thickened vein course. Possible causes: for example enlarged lymph nodes or tumors in the neck, larynx or upper chest. Accordingly, further complaints are possible.

If there is swelling on the face, including the eyelids, a pregnant woman should inform the gynecologist

© iStock / kupicoo

Lid and face edema during pregnancy

During pregnancy, the increase in the volume of fluid in the body is a normal process as long as it is somewhat compensated for by increased urine production. Otherwise swelling (edema) will form. Edema and edema, however, are not the same.

Swelling, especially on the legs, especially in the evening, is primarily a response to hormonal and mechanical effects. On the one hand, rising hormone levels lead to an increased fluid content of the tissues and to widening of the leg veins. Both of these promote leg swelling.

On the other hand, the enlarging uterus reduces the venous return flow of blood from the legs towards the heart. This can cause varicose veins to form, which in turn cause swelling and a feeling of heavy legs.

Edema of the hands or face, including the eyelids, is not a normal pregnancy-related change. Rather, they can - albeit as uncertain signs - indicate a possible impending pregnancy complication such as preeclampsia.

Preeclampsia is one of the most common reasons for giving birth prematurely. Pregnant women over the age of 40 and women with first and multiple pregnancies are particularly affected. In the clinical picture, which occurs predominantly in the second half of pregnancy, there is a loss of protein via the kidneys, and often pregnancy-related high blood pressure (measured values ​​from 140/90 mmHg).

Medical risk factors include conditions such as diabetes, kidney disease, pre-existing high blood pressure, autoimmune diseases, and preeclampsia in a previous pregnancy.

The gynecologist will check the blood pressure, body weight, protein excretion in the urine and various blood values ​​on a weekly basis in pregnant women who develop high blood pressure or who have risk factors for preeclampsia. In addition, the person concerned should check their blood pressure at home.

Of course, the gynecologist also closely examines whether the child is developing normally. Inpatient care is often recommended to be on the safe side. If necessary, treatment for high blood pressure can be initiated in the clinic.

Therapy to prevent preeclampsia is an option for women with an increased risk of the disease. It includes the intake of low-dose acetylsalicylic acid from early pregnancy up to about the 34th week of pregnancy.

The attending gynecologist will set the course in good time.
More information under "High blood pressure during pregnancy" on our partner portal https://www.baby-und-familie.de

Technical literature / further information:

Grehn F: Ophthalmology, 31st edition, Berlin Heidelberg Springer-Verlag, 2012

Lang GK: Augenheilkunde, 5th edition, Stuttgart Stuttgart Thieme Verlag, 2014

Mattle H, Mumenthaler M: Neurologie, 12th edition, Stuttgart Thieme Verlag, 2012
Bagheri N, Wajda BN: The Wills Eye Manual, 7th Edition, Philadelphia, London, Wolters Kluwer, 2017
Herold, Gerd and colleagues: Internal Medicine, 2019

Scully C: Cheilitis Granulomatosa Clinical Presentation, Online: https://emedicine.medscape.com/article/1075333-clinical (accessed on March 9, 2019)

Line line "Angioedema": Online: https://www.awmf.org/uploads/tx_szleitlinien/061-029l_S1_Hereditaeres-Angiooedem-durch-C1-Inhibitor-Mangel_2019-01.pdf (accessed on March 8, 2019)

Guideline "Malignant Melanoma" (DGO): Online: https://www.awmf.org/uploads/tx_szleitlinien/032-024OL_l_S3_Melanom-Diagnostik-Therapie-Nachsorge_2018-07_01.pdf (accessed on 09.03.2019)

Self-help group for patients with HAE:
HAE-Vereinigung e.V .. Online: www.hae-online.de (accessed March 9, 2019)

Guideline "https://www.awmf.org/uploads/tx_szleitlinien/015-018l_S1_Diagnostik_Therapie_hypertensiver_Schwangerschafts Krankungen_2014-verlaengert.pdf (accessed March 9, 2015; valid until November 30, 2017; currently being revised)


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Important NOTE:
This article contains general information only and is not intended to be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor.

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