Saturday, August 21, 2010

The Grotesquely Swollen Apple of My Eye- What to do When Bugs Attack Your Child's Face

Son #2 woke up this morning looking like a streetfighter!


Dramatic swelling of the eye(s) such as this can occur for a variety of reasons:
1. Allergic reaction to ingested food or drug (generally affects both eyes)
2. Direct contact with environmental allergen or food allergen (can affect one or both eyes)
3. Hereditary or acquired angioedema (can affect one or both eyes)
4. Injury (usually affects one eye)
5. Low protein levels (generally affects both eyes)

6. Infection (generally affects one eye)
7. Insect bite (can affect one or both eyes)

In this case, my little one endured a mosquito bite at the outer corner of his left eye yesterday afternoon.  It was mildly swollen at the time, and became progressively worse as the night wore on.

Does this mean he has a mosquito allergy? Actually, no more than anyone else.  Certain areas of skin, such as around the eyes and on the lips, are more loosely attached to underlying tissues and muscles than skin elsewhere on the body.  This allows these areas extra "give" and elasticity when reacting to the inflammatory enzymes in mosquito saliva.

How to treat a reaction like this?  My vote is conservatively:
1. Over the counter oral antihistmaine, such as Benadryl
2. Cool wet compresses
3. Ibuprofen if the area is tender
4. A three day course of oral steroids would be appropriate if the eye is sufficiently swollen that the child's vision is affected (your physician will likely want to evaluate your kiddo in person if this is the case). Because the eyes are a sensitive area of the body, I am generally reluctant to apply medium to high potency steroids directly to the skin surrounding the eye.

The above regimen should help even the most pronounced swelling go down within a couple of days.  Happily, the vast majority of these localized reactions can be managed in the home setting with excellent results, without the need for a doctor's visit or trip to the emergency room.

However, if you note generalized symptoms of an allergic reaction (such as swelling of other areas of the body, generalized hives, or shortness of breath), do not delay seeking medical attention, as there may be real risk of rapid progression of symptoms!

Friday, August 6, 2010