Drug-Induced Eyelid Edema: A Systematic Review

Eyelid edema is a common clinical presentation with multiple etiologies, some of which can pose life-threatening risks to patients. Isolated eyelid edema, without additional significant signs or symptoms, presents a diagnostic challenge. A growing number of drugs are associated with the development of eyelid edema, particularly new-generation small molecules. To identify the most frequently implicated drugs in this clinical scenario, we conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Forty-three studies met the inclusion criteria, identifying the drug groups most frequently associated with isolated eyelid edema: mammalian target of rapamycin (mTOR) inhibitors (sirolimus and everolimus), atypical antipsychotics (clozapine, risperidone, and olanzapine), fillers (hyaluronic acid and polyalkylimide), and oncologic drugs (imatinib and pemetrexed). The epidemiological characteristics of the patients in each group were highly variable and reflected the use of the aforementioned drugs in heterogeneous populations. The response to eyelid edema treatments also varied significantly. Patients with eyelid edema induced by atypical antipsychotics showed the highest response to conservative therapy, with a 100 percent response following either dose reduction or drug discontinuation. On the other hand, the response to conservative treatments for eyelid edema caused by oncologic drugs was inconsistent, with cases of persistent edema even after drug cessation. In these cases, blepharoplasty proved to be an effective and long-lasting solution. Lastly, in most filler-induced cases, an excellent response was observed following treatment with intralesional hyaluronidase.