😮 Facial swelling is a common presentation in both GP and A&E. It may arise from benign local causes (e.g., dental abscess) or be the first sign of a life-threatening emergency (e.g., anaphylaxis, SVC syndrome, orbital cellulitis). 👉 Always distinguish unilateral vs bilateral, local vs systemic, and look for red flags 🚨.

🩺 General Considerations

Facial swelling may be due to infection, allergy, trauma, systemic disease, or autoimmune causes. Clinical context is key.
Unilateral swelling 🤔: Suggests localised pathology (trauma, cellulitis, dental abscess).
Bilateral swelling 🟰: More often systemic (allergy, nephrotic syndrome, hypothyroidism, autoimmune disease).
Periorbital swelling 👁: May be local (conjunctivitis, sinusitis, trauma) or systemic (thyroid disease, nephrotic syndrome).
Associated symptoms: Fever, pain, itching, erythema, vision change, dyspnoea — guide urgency & cause.

🧾 Potential Causes

Cause	Key Clinical Features	Investigations	Management
🌸 Allergic Reaction (Angioedema)	Sudden, painless swelling (face/lips/eyelids); may have urticaria, wheeze, or stridor → risk of anaphylaxis.	Clinical diagnosis; IgE levels, allergy testing if recurrent.	Antihistamines, steroids; IM adrenaline for anaphylaxis; avoid triggers.
🦠 Cellulitis / Orbital Cellulitis	Painful, erythematous swelling; fever, malaise. Orbital cellulitis → painful eye movements, ↓ vision, proptosis.	Bloods (FBC, CRP), cultures, CT/MRI if orbital involvement suspected.	IV antibiotics; surgical drainage if abscess. Orbital cellulitis = emergency.
👃 Sinusitis	Facial pain/pressure, nasal congestion, periorbital puffiness, postnasal drip.	Clinical; sinus CT if chronic/recurrent.	Nasal decongestants, saline irrigation, antibiotics if bacterial, intranasal steroids if chronic.
🧂 Hypothyroidism (Myxoedema)	Non-pitting puffiness of face/eyelids; fatigue, dry skin, weight gain.	TSH, free T4.	Thyroxine replacement (levothyroxine).
💧 Nephrotic Syndrome	Morning periorbital oedema, frothy urine, anasarca, weight gain.	Urinalysis (proteinuria), serum albumin, renal function, renal US/biopsy.	Diuretics, salt restriction, ACEi; steroids or immunosuppressants depending on cause.
🤕 Trauma / Injury	Localised swelling ± bruising, pain, tenderness. Consider orbital fracture.	Clinical; X-ray/CT if fracture suspected.	Rest, ice, analgesia; surgery if fracture/severe haematoma.
🫁 SVC Syndrome	Swelling of face, neck, upper chest; dilated neck veins; dyspnoea, headache.	Chest X-ray, CT chest, venography.	Treat underlying malignancy (chemo, radiotherapy); SVC stenting if severe.
👁 Allergic Conjunctivitis	Periorbital swelling, itchy/red eyes, tearing, photophobia.	Clinical ± allergy testing.	Antihistamines, topical steroids, allergen avoidance.
🦷 Dental Abscess	Facial/jaw swelling, toothache, fever, gum discharge.	Dental X-ray, clinical exam.	Antibiotics, drainage, root canal or extraction.
🧬 Autoimmune (Lupus, Dermatomyositis)	Lupus → butterfly rash + oedema. Dermatomyositis → periorbital oedema, muscle weakness.	ANA, dsDNA, CK, aldolase; biopsy if needed.	Immunosuppressants (steroids, methotrexate, etc.).

🚩 Red Flags

⚡ Sudden severe swelling + dyspnoea → anaphylaxis → IM adrenaline.
👁 Eye pain, ↓ vision, proptosis → orbital cellulitis / cavernous sinus thrombosis → emergency.
🌡 Fever + malaise → infectious cause (cellulitis, sinusitis).
🙂 Facial paralysis/weakness → consider Bell’s palsy, stroke, or tumour.
📈 Persistent/progressive swelling → systemic disease or malignancy.
🫁 SVC syndrome → face/neck swelling + distended veins → urgent oncology input.

The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms.

Facial and Periorbital Swelling

🩺 General Considerations

🧾 Potential Causes

🚩 Red Flags

Categories