How is the external eye involvement of Epstein-Barr virus (EBV) infectious mononucleosis (mono) characterized, and what other findings of the periorbital area suggest a different diagnosis?

Updated: Sep 20, 2018
  • Author: Burke A Cunha, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Periorbital edema is caused by various agents. Periorbital edema is an uncommon, and therefore fairly specific, physical finding in infectious diseases. Bilateral periorbital edema not associated with generalized edema, eg, nephrotic syndrome, should suggest trichinosis, Kawasaki disease, allergic reactions, or bilateral periorbital cellulitis. Unilateral periorbital edema suggests conditions such as thyrotoxicosis, retro-orbital eye tumor, Chagas disease, insect sting, and unilateral conjunctivitis. EBV infectious mononucleosis is characterized by early and transient bilateral upper-lid edema.

In contrast to the disorders mentioned above, which are either unilateral or bilateral and involve the periorbital area, with or without the eyelids, the external eye involvement of EBV infectious mononucleosis is characterized by bilateral upper-lid edema. This finding first was described by Hoagland and is referred to as Hoagland sign (see Physical). In contrast, infectious mononucleosis is characterized by palpebral edema rather than periorbital edema.

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