A 41-year-old woman was referred to the Bascom Palmer Eye Institute inpatient consultation service with right periorbital edema. She had been transferred on the day of evaluation from another hospital. The patient first noted symptoms 5 days prior to evaluation. The swelling had increased in the interim and was now associated with decreased vision, erythema, and rubor.
The patient had undergone a tooth extraction from the right upper mouth 1 week prior to the onset of symptoms. Her ocular history was negative. Her medical history was significant for poorly controlled diabetes mellitus.
The differential diagnosis of severe periorbital edema associated with decreased vision in a diabetic patient includes orbital cellulitis (bacterial, fungal), cavernous sinus fistula, arteriovenous malformation, inflammatory pseudotumor, thyroid eye disease, and neoplastic processes. An infectious source is most likely given the patient's symptoms, findings, and recent tooth extraction.