| Conditions typically presenting bilaterally |
| Angioedema | | Often self-limited; avoid inciting agents Emergency medical attention is required in patients with upper airway obstruction; administer 0.3 mg of intramuscular epinephrine Mild cases may benefit from oral antihistamines and/or glucocorticoids: Diphenhydramine hydrochloride (Benadryl), 25 to 50 mg three or four times daily (dosage for children: 4 to 6 mg per kg per day, in three or four divided doses) Loratadine (Claritin), 10 mg daily (dosage for children two to five years of age: 5 mg daily) Prednisone, 0.5 to 1.0 mg per kg per day, then taper after three or four days
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| Atopic dermatitis | Fine scaling usually present Less edema than with contact dermatitis Other signs of atopic dermatitis may be present Family or personal history of allergic rhinitis or atopic dermatitis
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| Blepharitis | Yellow scaling at eyelid margins Patients may have pruritus or burning Less edema than with cellulitis or contact dermatitis; edema more prominent at eyelid margin
| Local measures: eyelid massage, warm compresses, and gentle scrubbing twice daily with a cotton swab and 1:1 solution of dilute baby shampoo or commercially available eyelid cleanser For staphylococcal infections, bacitracin or erythromycin ointment to eyelid margins at bedtime or one to two weeks For meibomian gland dysfunction, may add tetracycline, 250 mg four times daily, or doxycycline (Vibramycin), 100 mg three times daily, then taper after four weeks
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| Contact dermatitis | | Avoid inciting agents For allergic dermatitis, desonide 0.05% or alclometasone dipropionate 0.05% cream or ointment twice daily for five to 10 days For irritant dermatitis, cool compresses and a petroleum-based emollient applied at bedtime
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| Rosacea | Telangiectasias often present Onset over weeks to months Eyelid changes often accompany flushing, papules, and pustules of the nose, cheek, forehead, and chin
| Local measures as for blepharitis Systemic tetracyclines: Tetracycline, 250 mg four times daily Doxycycline, 100 mg three times daily Topical metronidazole 0.75% cream (Metrocream) or gel (Metrogel) twice daily Azelaic acid gel (Finacea) twice daily
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| Systemic processes | | |
| Conditions typically presenting unilaterally |
| Cellulitis* | Often presents with severe edema, deep violaceous color, and pain Onset over hours to days History of preceding trauma or bite
| Suggested oral regimen for patients with preseptal cellulitis only†: Amoxicillin/clavulanate (Augmentin), 875 mg twice daily or 500 mg three times daily (dosage for children older than three months: 40 mg per kg three times daily; dosage for children younger than three months: 30 mg per kg every 12 hours) Suggested intravenous regimens: Ampicillin/sulbactam (Unasyn), 1.5 to 3 g every six hours (dosage for children: 300 mg per kg daily, divided every six hours) Ceftriaxone (Rocephin), 1 to 2 g daily or divided every 12 hours (dosage for children: 50 to 75 mg per kg daily, divided every 12 hours) Parenteral antibiotics are often given for seven days in orbital cellulitis; transition to oral antibiotics if clinical improvement is noted after one week, to complete a total treatment course of 21 days
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| Herpes simplex | | Often self-limited; use supportive measures such as compresses Topical bacitracin may help prevent secondary infection Recurrent cases can be treated with long-term suppressive therapy: Acyclovir (Zovirax), 400 mg twice daily Valacyclovir (Valtrex), 500 mg to 1,000 mg daily Famciclovir (Famvir), 250 mg twice daily
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| Herpes zoster ophthalmicus | Older adults Vesicles often present Pain or burning Onset over hours to days
| Cool compresses Acyclovir, 800 mg five times daily for seven to 10 days; valacyclovir, 1 g three times daily for seven days; or famciclovir, 500 mg three times daily for seven days Early initiation of tricyclic antidepressants (desipramine [Norpramin], 25 to 75 mg at bedtime) may inhibit postherpetic neuralgia Patients may require additional treatment for complications such as keratitis and glaucoma
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| Tumors | | |