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Suggest Treatment For Pain, Swelling And Itching Around The Left Eye

Posted on Wed, 26 Aug 2015

Question: Greetings, Dr. Chail. Previously I wrote about my 56 year wife's swelling and slight itching around her upper left eye which we thought was allergic correlated with Advil. Apparently it isn't because she is experiencing it even with taking any Advil. She saw an ophthalmologist who who felt it was some kind of allergy and gave her some drops. She also asked an ENT about it. She also experiences puffiness around the other eye with occasional slight tearing, but with no itchiness. So as of now it is unknown why she is experiencing the slight swelling in either case, unless it does have to do with some blockage of lymph glands around that single eye. It comes and goes, and in general as she has gotten older both her eyelids have gotten puffier.

Answered by Dr. Riyanka Chail (7 hours later)

Brief Answer:
Multiple causes require attention in stepwise approach

Detailed Answer:
Hi Davic1,
Thanks for writing in to hcm.
This is Dr.Riyanka answering your query.

Sinus infections might be the most important cause that needs to be evaluated as it is mentioned that she had it in the past. If she has got a recent imaging of sinuses and clinical evaluation done which is normal then other causes require attention.

The following conditions are important to be ruled out clinically apart from sinusites and the local drainage of tears and lymphatic fluids.

(i) One of the important causes might be nephrotic syndrome. This is a condition in the kidneys where there is accumulation of water and fluids in the face.
(ii) Any steroid dependent condition like Cushing's syndrome might also be a possible cause.
(iii) Malnutrition states are commonly associated with this symptom, however I guess your wife does not have any nutritional deficiency that might be causing it.
(iv) Metabolic conditions like hypoproteinemia or hypoalbuminemia are also conditions which need to be considered when evaluating facial puffiness.
(v) Edema elsewhere in the body might also appear as puffiness of the eyes.

I suppose a general clinical examination and required tests might help understand the cause of the intermittent puffiness.

Hope this answered your query.
Please do write back for more queries.

Regards,
Dr.Riyanka

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Riyanka Chail (22 hours later)

Thank you very much. Would these various conditions apply possibly even if her puffiness around the eyes comes and goes randomly? For instance, today her eyes seemed pretty normal.

Also what are the specific test names for testing the kidneys or the metabolic syndrome? Or for finding some edema? I guess another possibility could be reactions to facial creams and shampoos?

Answered by Dr. Riyanka Chail (10 hours later)

Brief Answer:
Please get the belowmentioned renal function tests done

Detailed Answer:
Hi XXXX,
Thanks for writing in to hcm.
thank you for the updates.

I have analysed the updates and i suggest puffiness of the face and the renal causes for it should be investigated.

Therefore kindly get renal function tests like :
1. Serum creatinine
2. Blood urea
3. Urine analysis for proteins.

Also basic liver function test is also recommended to rule out any elevated liver enzymes.

Usage of shampoo and facial creams can cause puffiness but is there any history of recent change in the product used?
Also pleas ask the patient to stop using the present cream and only use petroleum jelly or an unperfumed emollient instead of cosmetics for few days and try and notice the change.

Hope this answered your query.
Please do write back for more queries.

Regards,
Dr.Riyanka

Above answer was peer-reviewed by : Dr. Vaishalee Punj