Angioedema of the eyelids

Angioedema of the eyelids (Quincke's edema) is a common allergic complication of general antibiotic therapy and the use of other medications. Quincke's angioneurotic edema of the eyelids and orbit was first described by P. Quinck in 1882. It usually occurs as an immediate-type allergic disease, affecting the skin, larynx, gastrointestinal tract, etc. Generalized Quincke's edema occurs with fever, general weakness, and changes in the white blood cell formula. In terms of etiology and pathogenesis, it is largely similar to urticaria, and therefore both diseases are often described together.

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

Symptoms of Quincke's angioedema of the eyelids and orbit

Ocular manifestations of Quincke's edema may be a symptom of a more widespread process, but ophthalmologists much more often observe the development of edema only in the eyelid area, sometimes the eye socket or eyelids and eye socket together. The pathology is quite rare, unlike other localizations, it mainly affects children of preschool and primary school age, proceeds without noticeable signs of a general reaction of the body, although subfebrile temperature, lethargy, loss of appetite may occasionally be observed. The disease begins suddenly, against the background of good health of the child. Edema of the upper and lower eyelids usually of one eye appears, which quickly, if severe, spreads to the skin of the cheek, corner of the mouth and below. In some patients, the affected half of the face noticeably increases in volume compared to the healthy one, while in others the edema is limited to the eyelids, even only the upper eyelid, and only narrows the eye slit. The edematous skin is pale, sometimes with a bluish tint. The absence of skin hyperemia, soreness on palpation and spontaneous pain distinguishes such edema from inflammatory.

Edema of the eyelids is usually not accompanied by hyperemia. It is characterized by severe itching, rapid development, short duration and disappears without a trace when the allergen (drug) action ceases. Sometimes edema of the orbital tissue and exophthalmos of varying degrees occur simultaneously. The edema can spread to all parts of the eyeball (allergic Vickers edema), accompanied by an increase in intraocular pressure. If the allergen, the main cause of the disease (occupational drug allergy, polyvalent allergy), is detected late, irreversible changes may develop or the process may become generalized with damage to the mucous membranes of the larynx (the so-called vitreous edema), digestive tract, genitourinary tract, accompanied by dysfunction of the corresponding organs, often an increase in body temperature. It should be taken into account that a patient who has had angioedema in the past may develop severe anaphylactic shock as a result of exposure to an allergen.

In case of massive Quincke's edema of the eyelids, there may be chemosis of the conjunctiva, point superficial infiltrates may appear on the cornea, secondary glaucoma is not excluded. Edema of the orbit is characterized by acutely developing exophthalmos with displacement of the eyeball straight forward, its good mobility. Simultaneous damage to the eyelids and orbit is manifested by edema of both. Sometimes edema is preceded by itching of the eyelids, a feeling of their heaviness, whims of the child. There may be eosinophilia in the blood. Eosinophils (acidophiles) can be detected in the lacrimal fluid and scrapings from the conjunctiva.

During the first attacks, the swelling, having lasted from 12 hours to several days, disappears as suddenly as it appeared, leaving no trace, and the disease can end in one attack. During relapses, the intervals between attacks fluctuate from several days to weeks and months. Repeated relapses leave more and more noticeable remnants of swelling, the eyelids enlarge, even their elliphantiasis has been described.

The described clinical picture is quite typical, and nosological diagnostics of Quincke's edema of the eyelids (and orbit) is usually not difficult. In addition to inflammatory edema, it should be differentiated from Meige's disease (trophedema), characterized by prolonged edema of the subcutaneous fat tissue of the base of the lower eyelids, which is not affected by antihistamines or corticosteroids.

Much more difficult is etiological diagnostics, the task of which is to identify the allergen in a specific patient. Such an allergen can be any of many hundreds. The causes of the disease can be congenital intolerance (atopy) of any food, household, pollen and other factors, acquired sensitivity to them (anaphylaxis), as well as to medications, chemicals, etc., various 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 helminth eggs, implementation of anthelmintic therapy even in cases where worms are not detected, deserves the attention of ophthalmologists. According to observations of Yu. F. Maychuk (1983), in adults, the most common cause of Quincke's edema in the area of the visual organ are antibiotics, sulfonamides, salicylic drugs, enzymes used parenterally and orally, and both eyes are most often affected. Idiopathic hereditary (familial) Quincke's edema of non-allergic genesis in the eye area apparently does not occur.

Diagnostics of Quincke's angioedema of the eyelids and orbit

Identification of exoallergens in Quincke's edema of the eyelids (and orbit) is complicated by negative responses of skin tests even to obvious irritants. It is therefore important to carefully collect an allergological anamnesis.

[ 5 ], [ 6 ]