Cold urticaria: An underrecognized cause of postsurgical periorbital swelling

Purpose: To report cold urticaria as an underrecognized cause of potential periorbital and facial edema after elective oculofacial plastic surgery. Methods: Retrospective case series of three patients with primary acquired cold urticaria with review of the clinical aspects of each of the cases. Results: Two of the patients had significant postoperative swelling attributed to primary acquired cold urticaria after the routine use of cool compresses to their surgical sites. The third patient had known primary acquired cold urticaria and required special perioperative management. All three patients ultimately had a good surgical outcome with no long-term sequelae. Conclusions: Although primary acquired cold urticaria is generally not a serious condition, it can be easily overlooked and misdiagnosed as a localized adverse reaction to injected anesthetic, topical antibiotic ointments, or early preseptal cellulitis after eyelid or facial surgery. Rarely, this condition can be fatal and should be recognized by the surgeon to ensure both optimal surgical results and general medical management. Three simple screening questions should identify most patients with this disorder.