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Swollen face near eyes and nose, black eye

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ENT Specialist
Practicing since : 1991
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My daughters recently went to the family doctor because she all of a sudden had black eyes and her face was swollen on the eyes and nose area. She could find anything wrong with her sinus area and sent her to get a facial and neck xray. That came back with no visable signs of anythings. Now the doctor is ordering her to a Ear, Nose and Throat doctor. We are concerned that this is rather serious and want to make sure everything is done quickly to get a dianosis. Why wouldn't they order a MRI or Cat Scan right now. the pain in her face moves which puzzeled her family doctor. Have you ever heard of something that does this.
Posted Sat, 21 Apr 2012 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Sumit Bhatti 1 hour later
Dear XXXXXXX

Thank you for your query.

1. Spontaneous Black Eyes without a cause is rare.
2. Does she have pain, fever or swelling?
3. Are there any visual problems? Is there blurring or double vision?
4. Is there any inability to move the eyes in any particular direction?
5. Is there any nasal bleeding or discharge? Is there any bleed in the eye itself?
6. Is there any history of unconsciousness?
7. Is there any history of a blow to the eyes or nose? or an assault / accident / fall (an orbital blow-out because the bony lamina between the eye and nose is extremely wafer thin)?
8. Is there any history of severe sneezing, headache or sinusitis?
9. Has a coagulogram been done?
10. Is the black eye all around (Racoon eyes) or only below the eyes? You may send a photo to YYYY@YYYY with 'Attn: Dr. Sumit Bhatti' in the subject line.

The face has loose tissue around the eyes and the collection of blood and inflammatory fluid would shift and drag tissue causing shifting pains.

Further discussion will be easier after you answer these questions,

Regards.
Above answer was peer-reviewed by
 
Follow-up: Swollen face near eyes and nose, black eye 2 days later
2 pain and swelling
3 no visiual problems
4 can move eyes but it hurts
5 no
6 no
7 no
8 no
9no
10 mostly under the eyes. The pain started over a week ago and under the eyes started changing colors a week ago.
I will send a picture
She went to the doctor and they has a facial xray done and nothing came back from that, also no sinus problems that the doctor could see, tomorrow she will be going to a nose, throat and ear doctor.
 
 
Answered by Dr. Sumit Bhatti 56 minutes later
1. Since you have answered in the negative for most of the causes and she has no visual problems, the causes may be narrowed down. Pain and swelling may signify a pre-septal (peri-orbital) cellulitis. Pain on moving eyes suggests that the infection or inflammation may be spreading to the post-septal compartment of the orbit and may result in orbital cellulitis.
2. Some causes are:
a) Local bruising,
b) Insect bites,
c) Spread via blood from adjacent sites such as sinuses or infected teeth or distant site, usually bacterial. (X-ray's may not pick up mild sinusitis).
d) Sleeping with eye make-up on
e) Lacrimal gland and duct infections, bacterial or viral.
3. As her condition is on both sides, and common causes have been ruled out, it is intriguing. It is now important to note the actual clinical examination findings of your local E.N.T. Specialist and the photograph. This may shed some light as to the cause of this condition.
4. If her condition is improving, you should supplement antibiotics and anti-inflammatory medication, local ointment and fomentation. Hemorrhage (bleeding) under the skin will change color and slowly disappear as the blood and pigments are absorbed back into the body. There are creams to hasten this but are not to be applied to the delicate skin around the eyes.
5. If her condition does not improve or worsens, for example if she has restricted eye movements or visual problems, you must insist on a USG Orbit, a CT Orbit or an MRI Orbit. This is because orbital cellulitis spreads quickly and requires aggressive treatment.

You should also get an Ophthalmologist's opinion and get her coagulogram and full blood count done.

I hope she has some minor cause and at her age, she should recover soon.

Regards.
Above answer was peer-reviewed by
 
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