Eye Redness with Inner Canthus Swelling After Rubbing

Most Likely Diagnosis

Mechanical conjunctival trauma from rubbing is the primary consideration given the clear temporal relationship and absence of pain or discharge, with the inner canthus lower lid location suggesting either conjunctival chalasis or localized conjunctival edema from direct mechanical irritation 1
Mucus fishing syndrome should be considered if there is a pattern of repetitive rubbing to remove mucus, creating a cyclical inflammation with conjunctival injection and staining of the inferior fornix 2

Preseptal cellulitis should be excluded, characterized by warmth, tenderness, or progression of swelling, requiring urgent evaluation 3
Malignancy masquerading as inflammation, such as sebaceous carcinoma, should be considered in chronic unilateral presentation unresponsive to conservative measures, especially in elderly patients, warranting biopsy consideration 4

Stop all rubbing immediately, as this is the most critical intervention 2
Apply cool compresses to reduce acute edema 1
Use preservative-free artificial tears frequently to address any underlying irritation driving the rubbing behavior 1

Return immediately if vision changes occur, which may suggest corneal involvement or infection 3
Routine follow-up in 1-2 weeks is recommended if symptoms persist despite conservative measures, or if the pattern suggests a chronic or recurrent issue requiring evaluation for underlying causes 1, 2, 6

Do not prescribe topical antibiotics empirically without evidence of infection, as this only adds preservative exposure and potential toxicity 1
Do not use topical corticosteroids without slit-lamp examination to rule out corneal pathology, as steroids can worsen herpetic or fungal infections and cause glaucoma 7, 3
Do not dismiss chronic unilateral cases as simple irritation, as sebaceous carcinoma can present as chronic unresponsive unilateral inflammation 4, 5