Angioedema of the eyelids

Angioedema of the eyelids (Quincke's edema) is a frequent allergic complication of general antibiotic therapy and the use of other medications. Quincke's angioedema and eyecups were first described by P. Qninck in 1882. Usually occurs as an allergic disease of immediate type, affecting the skin, larynx, gastrointestinal tract, etc. Generalized Quincke's edema occurs with fever, general weakness, changes in the formula of white blood . On etiology and pathogenesis, it is similar in many respects to urticaria and therefore often both diseases are described together.

[1], [2], [3], [4]

Symptoms of angioedema angina Quincke's eyelids and orbits

Eye manifestations of Quincke's edema may be a symptom of a more common process, however ophthalmologists are much more likely to observe edema development only in the eyelid region, sometimes orbits or eyelids and orbits together. The pathology is quite rare, unlike other localizations, it affects mainly children of preschool and primary school age, it proceeds without noticeable signs of the general reaction of the organism, although subfebrile condition, lethargy, loss of appetite can occasionally be observed. The disease begins suddenly, against the background of the child's good health. Appears edema of the upper and lower eyelid usually one eye, which quickly spreads with great intensity to the skin of the cheek, angle of the mouth and lower. In some patients, the affected half of the face significantly increases in volume compared with healthy, while in others the edema is limited to centuries, even only by the upper eyelid, and only narrows the eye gap. The oedematous skin is pale, sometimes with a bluish tinge. Absence of skin hyperemia, tenderness in palpation and spontaneous pain distinguishes such an edema from inflammatory.

Edema of the eyelids, as a rule, is not accompanied by hyperemia. It is characterized by severe itching, rapid development, short duration, and disappears without a trace on the cessation of the action of the allergen (medicines). Sometimes, there is an edema of the orbital fiber and exophthalmus of different degrees. Edema can spread to all parts of the eyeball (Vickers allergic edema), accompanied by increased intraocular pressure. With the late detection of the allergen, the main cause of the disease (professional medical allergy, polyvalent allergy), irreversible changes can develop or the process can take a generalized character with the lesion of the mucous membranes of the larynx (the so-called vitreous edema), the digestive tract, the genito-urinary tract, accompanied by the disorder of the function of the corresponding organs , often with an increase in body temperature. It should be borne in mind that a patient who has had an angioedema in the past, due to ingestion of an allergen, may develop a severe anaphylactic shock.

With the massive edema of the Quinckus, the eyelid can be hemozyme of the conjunctiva; on the cornea, there may appear point superficial infiltrates, secondary glaucoma is not excluded. The ophthalmic edema is characterized by a sharply developing exophthalmos with a shift of the eyeball directly forward, its good mobility. Simultaneous lesion of the eyelids and orbit is manifested by the edema of both. Sometimes the swelling is preceded by the itching of the eyelids, the sensation of their heaviness, the whims of the child. In the blood there may be eosinophilia. Eosinophils (acidophils) can be found in tear fluid and scrapings from the conjunctiva.

At the first attacks, edema, lasting from 12 hours to several days, disappears as suddenly as it appeared, leaving no trace, and the illness can end with a single attack. With relapse, the intervals between attacks range from a few days to a pedal and months. Repeated recurrences leave more and more noticeable remnants of edema, eyelids increase, even their elifanthiasis is described.

The described clinical picture is quite typical, and the nosological diagnosis of Quincke edema (and eye sockets) is usually not difficult. In addition to inflammatory edema, it must be differentiated from the disease of Meij (trophadema), characterized by a prolonged swelling of the subcutaneous fat of the base of the lower eyelids, which is not affected by antihistamines, pi corticosteroids.

The etiological diagnosis is much more difficult, the task of which is to reveal the allergen in a particular patient. Such an allergen can be any of many hundreds. Causes of the disease may be congenital intolerance (atopy) of any food, domestic, pollen and other factors, acquired sensitivity to them (anaphylaxis), as well as to medicines, chemicals, etc., a variety of endogenous causes. Among the latter, both in general and in eye allergies, great importance is attached to helminthic invasion. The recommendation of careful, repeated testing of the patient for eggs of worms, the implementation of anthelmintic therapy, even in cases where worms are not found, deserves the attention of oculists. According to Yu. F. Maychuk (1983), in adults, the most frequent cause of edema in the area of the organ of vision is applied parenterally and orally, antibiotics, sulfonamides, salicylic preparations, enzymes, and both eyes are more often interested. Idiopathic hereditary (familial) Quincke edema of non-allergic genesis in the eye area, apparently, does not occur.

Diagnosis of angioedema, angioedema and eye sockets

Identification of exoallergens in the Quincke edema (and eye sockets) is hampered by negative responses of skin tests, even to obvious stimuli. So it is more important to carefully collect an allergic anamnesis.

[5], [6]