38/ f with c/ o painless swelling at medial end of both eyes since one yr. k/c/o migraine. no other eye complaints or comorbidities swelling noticed to be more in morning n subsides in the evening. any inputs on diagnosis plz??

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Look like bilateral orbital fat herniation from upper orbital septa with probably weak medial horns of LPS aponeurosis, waxing & vaning seems be due to hydration, gravity & intraorbital pressure related, look for thyroid function tests Also rule out angioedema of early blepherochalasis

She is kco of migraine. So headache is explained . So far swellings are concerned seems to be nonspecific as it appears in morning and sub sides in evening i have not come across such dacryocystitis any should be investigated.

This is loose skin with underlying soy tissue dacrocystitis is inferior at the lacrimal sac and is painless ask the patient to do lid exercise . May require cosmetic surgery

How exactly is the lid exercise done sir
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Any h/o unusual lacrimation. Needs to undergo diagnostic nasal endoscopy, CT. Dx. Chronic dacryocystitis Rx. Dacryocystectomy, dacryocystorhinostomy and stenting.

Also x Ray pns for r/o ethmoid sinusitis.
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It may be due to ethmoidal sinusitis also?

It looks to me as if there's a generalized puffiness of eyelids. Any drug history like chronic steroid use? Check for facial puffiness. I would suggest a thyroid profile. Also, urine examination particularly for proteins.

Very good explanation
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Dacryocystitis both eyes

BILTRAL BLEPHROCHLIASIS NEEDS BLEPHROPLASTY

The duration of illness has not been mentioned X Ray PNS or more precisely MR scan for the sinuses may ba advised. A trial for steam inhalation with plain water twice daily may be given.

Duration almost a year sir
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Bilateral Herniation of orbital fat.

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