bubble_chart Concept

Eyelid erysipelas refers to the condition where the skin of the eyelid is as red as if painted with vermilion and feels as hot as if scorched by fire. Because it often causes swelling of the head and face, it is also known as "fire-swollen big head."

This condition was first mentioned in Chuangyang Jingyan Quanshu, referred to as "upper and lower reddened eyelid." Zhengzhi Zhunsheng called it "fire-swollen big head." Waike Qixuan and Waike Zhengzong simply referred to it as "reddened eyelid."

Both "stye" and this condition occur at the edge of the eyelid, and their causes are generally similar. However, a stye is milder, usually presenting as a localized small nodule; eyelid erysipelas is more severe, with the entire eyelid swollen, red, painful, hard, and tender to the touch, often accompanied by systemic symptoms such as chills, fever, and headache. Therefore, stye is discussed separately and is not within the scope of this article.

bubble_chart Pattern Analysis

1. Wind-heat Conflict︰The eyelid is diffusely swollen, red, and painful, with hard nodules that resist pressure. In severe cases, the face and head may swell significantly, accompanied by excessive eye discharge and tears, along with aversion to cold with fever, dysphoria, and restlessness. The tongue coating is thin and white, and the pulse is floating and rapid. Alternatively, symptoms may include dry mouth, thirst, high fever without aversion to cold, a red tongue with slightly yellow coating, and a rapid, forceful pulse. This condition is often caused by the combination of wind and heat pathogens battling internally and lodging in the eyelid. The key diagnostic features are diffuse swelling, redness, and pain in the eyelid with hard nodules resisting pressure, along with aversion to cold and fever. If wind predominates over heat, aversion to cold is severe, fever is mild, there is no thirst, the tongue coating is thin and white, and the pulse is floating and rapid. If heat predominates over wind, symptoms include dry mouth, thirst, severe fever, mild aversion to cold, or even high fever without chills, a slightly yellow tongue coating, and a rapid, forceful pulse. Treatment involves dispersing wind and clearing heat, as well as clearing heat and removing toxins. The recommended formula is Universal Relief Decoction for Eliminating Toxin.
2. Dampness-heat︰The eyelids, cheeks, and face are red with a slight yellowish-white hue, accompanied by a burning, itchy, and painful sensation. There may also be wind foxtail millet, eczema, and erosion. Symptoms include heaviness of the head, fatigue, heaviness and sluggishness in the limbs, chest tightness, reduced appetite, yellow and scanty urine, a yellow and greasy tongue coating, and a soggy, rapid pulse. The condition involves heat combined with dampness, leading to differences in disease cause, pathogenesis, and main symptoms.

Dampness-heat obstruction causing reddened eyelids is often due to internal accumulation of dampness-heat in the spleen and stomach, which obstructs and rises to the head and eyes, settling in the eyelids. The key diagnostic points are redness of the eyelids and cheeks with a slight yellowish-white tint, moist erosion, itching, and pain. Internal accumulation of dampness-heat leads to symptoms such as heaviness of the head, fatigue, heaviness in the limbs, chest tightness, reduced appetite, a yellow and greasy tongue coating, and a soggy and rapid pulse. Treatment should focus on clearing heat and draining dampness, and the recommended formula is Dampness-Expelling Stomach Poria Decoction.

bubble_chart Documentation

1. Shenshi Yaohan．Eye Pain》: "Head distension and big head syndrome. This syndrome is characterized by red eye pain, and swelling of the head and face, with internal dryness and red skin, resembling big head cold-damage disease, commonly seen in summer. There is dampness-heat and wind-heat, dampness-heat causes excessive tearing and skin ulceration; wind-heat causes distending pain and aversion to cold. If not treated, blood stasis will occur internally, and even if the swelling subsides, the eyes will inevitably develop complications."
2. Waike Zhengzong．Reddened Eyelid》: "Reddened eyelid is caused by wind in the spleen meridian and excessive heat in the stomach meridian, which combine to form swelling. If wind is predominant, the swelling is easily reduced; if heat is severe, the swelling is hard and difficult to disperse. At the onset, apply Jinhuang Powder. For those with exterior pattern Schizonepeta and Saposhnikovia Toxin-Vanquishing Powder; for those with interior pattern Stomach-Clearing Powder with Rhubarb Rhizoma to promote diuresis. If the swelling does not disperse later, it will likely form pus, and the plaster should be changed. If pus forms, it should be punctured immediately; otherwise, the eye will rupture on its own. However, this is the area of the Jingming acupoint where the flesh is hollow and difficult to heal, so fistula disease often results."
3. 《Ophthalmology Treatment Experience．Eyelid Erysipelas》: "Mainly caused by heat in the blood aspect, deficiency of the muscle interstices, and wind-dampness pathogenic heat taking advantage of the deficiency to invade the head and face meridians. 'All pain, itching, and sores belong to the heart,' the lung governs the skin and body hair, and the spleen governs the muscles, so the disease originates from the heart, lung, and spleen meridians."