Edema without a modifier usually refers to peripheral or dependent edema, the accumulation of fluid in the parts of the body that are most affected by gravity. In ambulatory people these are the legs, although in those who are bedbound the first manifestation may be sacral edema. If severe enough, peripheral edema may progress to involve the abdominal or even thoracic wall (this may be referred to as generalized edema or (anasarca). In particular edema states (e.g. nephrotic syndrome, see below), periorbital edema (around the eyes) may be present.