What is the cause of my husband’s eye problem?
Q My husband woke up the other morning and felt a lump in his eyebrow. The next morning the eye was red and swollen and remained that way for a couple of days. Strangely, that exact same thing happened when we were in holidays last year and we assumed it was an insect bite but there is no way that the same insect would be in Ireland in winter and Spain in August. Should he get this checked out?
A It sounds like your husband may had a common and generally mild condition called periorbital cellulitis, an infection of the outer visible portion of the eyelid, not involving the eye orbit or other eye structures. Although his infection may have started in his eyebrow, it quickly tracked down into his eyelid the following day.
This is in contrast to the much less common (albeit much more serious) orbital cellulitis which can be distinguished from periorbital cellulitis by its clinical features. These worrisome clinical features for orbital cellulitis include difficulty with eye movements called ophthalmoplegia which tends to cause double vision, pain with eye movements, reduced vision, and a propping forward/outward of the eye called proptosis.
In your husband’s case, he clearly did not have any worrisome features as these would lead to an urgent referral to a specialist eye hospital. The typical presenting symptoms of periorbital cellulitis include eye pain, eyelid swelling and redness on the affected side only. One of the most common causes of periorbital cellulitis is an underlying sinusitis or a recent prolonged/worsening upper Respiratory Tract Infection (RTI). If no evidence of sinusitis/recent RTI can be found then the periorbital cellulitis may arise from infection of the surrounding skin and soft tissues of the face and eyelid. Indeed, as in your husband’s case, he most likely suffered local skin trauma (eg, an insect/animal bite) as this is another common cause. One last thing to consider is the possibility of a local allergic reaction, for example to the recent use of a topical eye drop or to an insect sting as this presents in a similar fashion to periorbital cellulitis.
When periorbital cellulitis becomes recurrent, it is usually due to an underlying cause that has not been diagnosed such as allergies or chronic sinusitis. Initiating treatment of the underlying cause will prevent further recurrent episodes. The definition of recurrent periorbital cellulitis is three or more episodes within a year. In your husband’s case he appears to have suffered two infections in less than one year. I suggest you continue to monitor the situation for now. He should consider attending his GP for a routine health check. This would most likely include a screen for diabetes as this can lead to recurrent skin infections or thrush in some people. It is always good to know his cholesterol, blood pressure and organ function are in a normal range.
Consider the obvious things like following a healthy diet, getting plenty of refreshing sleep, at least three days of moderate intensity exercise, limiting stress and alcohol consumption, and taking multivitamins especially vitamin D and omega 3 supplements.