Facial Edema is swelling of the face that may be localized — such as around the eyes — or generalized, sometimes extending to the neck and upper arms. It can develop gradually or abruptly, may be painful, and occasionally precedes peripheral or generalized edema. Mild edema may go unnoticed until reported by the patient or a familiar observer.

Pathophysiology

Facial edema results from disruption of hydrostatic and osmotic pressures that regulate fluid movement between arteries, veins, and lymphatics. Mechanisms include:

• Allergic/Immune reactions: Histamine or immune-mediated responses increase vascular permeability, leading to swelling.

• Venous obstruction: Superior vena cava syndrome or thrombosis causes impaired drainage and fluid accumulation.

• Trauma: Injury to facial tissues increases local capillary permeability and inflammatory fluid accumulation.

• Systemic disorders: Conditions like nephrotic syndrome, myxedema, preeclampsia, or malnutrition alter osmotic pressures and fluid balance.

• Drug- or procedure-related edema: Long-term corticosteroids, contrast media, transfusions, surgery, or radiation therapy can induce fluid retention.

Signs and Symptoms

• Swelling of the face, periorbital areas, eyelids, cheeks, or generalized facial swelling

• Pitting or nonpitting edema, depending on cause

• Redness, warmth, or tenderness over affected areas

• Pain or burning sensation in localized cases

• Dyspnea, inspiratory stridor, or airway compromise in severe allergic reactions or burns

• Associated systemic features: fever, malaise, headache, nausea, blurred vision, or hypertension (depending on underlying cause)

Clinical Assessment

History

• Onset: sudden or gradual; early morning prominence or progression throughout the day

• Associated symptoms: weight gain, urine changes, appetite changes, respiratory distress

• Recent trauma, allergy exposure, infections, surgery, transfusions, or drug intake

• Past medical history: renal, cardiac, endocrine, or systemic disorders

Physical Examination

• Inspect for localized vs. generalized edema, pitting vs. nonpitting, and severity

• Assess vital signs and neurologic status

• Examine oral cavity, oropharynx, and ocular structures

• Check for signs of systemic involvement: hypertension, JVD, fever, exophthalmos

Medical Causes of Facial Edema

Other Causes

Special Considerations

• Administer analgesics and antipruritic creams as indicated

• Apply cold compresses to periorbital areas if appropriate

• Elevate head of bed to promote fluid drainage

• Order urine and blood tests to identify underlying cause

• Monitor airway for obstruction and administer oxygen or epinephrine if needed

Patient Teaching

• Educate on early signs of allergic reactions and when to seek urgent care

• Discuss avoidance of known allergens, insect bites, or irritants

• Emphasize importance of carrying an anaphylaxis kit and wearing medical identification

Pediatric Pointers

• Children have lower periorbital tissue pressure → more prone to periorbital edema

• Common causes: heart failure, acute glomerulonephritis, pertussis

• Examine child in supine position; otoscopic or oral exams last to minimize distress

References

• El-Domyati M, El-Ammawi TS, Medhat W, Moawad O, Brennan D, Mahoney MG, et al. Radiofrequency facial rejuvenation: Evidence-based effect. J Am Acad Dermatol. 2011;64(3):524–535.

• Knaggs H. A new source of aging? Cosmetol Dermatol. 2009;8(2):77–82.

• Boron WF, Boulpaep EL. Medical Physiology. 3rd ed. Philadelphia: Elsevier; 2012.

• Goldsmith LA, Katz SI, Gilchrest BA, et al. Fitzpatrick's Dermatology in General Medicine. 8th ed. New York: McGraw-Hill; 2012.

• James WD, Berger TG, Elston DM. Andrews' Diseases of the Skin: Clinical Dermatology. 13th ed. Philadelphia: Elsevier; 2019.