A person may experience swelling in one or both eyelids. Swelling may be painless or accompanied by itching or pain. Eyelid swelling is distinct from bulging eyes, although a few disorders can cause both.
Causes
Eyelid swelling has many causes (see table Some Causes and Features of Eyelid Swelling). It usually results from an eyelid disorder but may result from disorders in and around the eye socket (orbit) or from disorders elsewhere in the body that cause widespread swelling.
Common causes
The most common causes of eyelid swelling are allergic, including
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Local allergy (contact sensitivity)
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More widespread allergic reaction (for example, angioedema or allergic rhinitis)
Less common causes
Less common causes of eyelid swelling include
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Disorders that cause generalized body swelling, particularly a type of kidney disease called nephrotic syndrome
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Bacterial infection of the skin of the eyelids and around the eyes (preseptal or periorbital cellulitis)
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Chronic inflammation of the eyelid margins (blepharitis)
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Underactive thyroid gland (hypothyroidism)
An overactive thyroid gland can cause bulging eyeballs but does not cause swollen eyelids.
Rare but dangerous causes of eyelid swelling are infection within the orbit and around and behind the eye (orbital cellulitis) and blockage of a vein at the base of the brain by an infected blood clot (cavernous sinus thrombosis).
Some Causes and Features of Eyelid Swelling
Cause |
Common Features* |
Diagnosis† |
Eyelid disorders |
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Allergic reaction affecting only the eyes |
Itching but no pain Pale, puffy eyelid or eyelids and sometimes pale, puffy conjunctiva (the membrane that lines the eyelids and covers the front of the eye) Sometimes in people who have had a previous episode, been exposed to an allergen, or both Affecting one or both eyelids |
A doctor's examination |
|
Blepharitis (inflammation of the edges of the eyelids) |
Yellow crusts on lashes Eye itching, burning, redness, sores, or a combination Sometimes accompanied by seborrheic dermatitis (inflammation of the skin characterized by greasy scales on the scalp and face) Usually affecting both eyelids |
A doctor's examination |
|
Blepharitis caused by herpes simplex virus |
Clusters of fluid-filled blisters on reddened skin, open sores, and significant pain Usually affecting only one eye (may affect both eyes in children) |
A doctor's examination |
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Chalazion (enlargement of an oil gland deep in the eyelid) |
An area of redness and pain on only one eyelid Eventually development of a round, painless swelling away from the edge of the eyelid |
A doctor's examination |
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Conjunctivitis, infectious (pinkeye, or inflammation of the conjunctiva, caused by bacteria or a virus) when severe |
Redness of the white of the eyes, a discharge, and sometimes crusts on the lashes when the person wakes up Affecting one or both eyes |
A doctor's examination |
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Clusters of fluid-filled blisters on reddened skin, open sores, and significant pain Usually affecting only one eye with skin rash adjacent |
A doctor's examination |
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Stye (hordeolum) |
Redness and pain affecting one eyelid Eventually swelling at the edge of the eyelid, sometimes with small, raised, pus-filled bumps |
A doctor's examination |
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Insect bite |
Itching, redness, and sometimes a small, raised bump |
A doctor's examination |
Disorders in and around the orbit |
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Cavernous sinus thrombosis (blockage of a vein at the base of the brain by an infected blood clot)‡ |
Headache, bulging eyes, weak eye muscles with double vision, a drooping eyelid, loss of vision, and fever Usually affecting one eyelid first, then the other eyelid Symptoms of sinusitis (pain behind the eyes or in the face that worsens when the head is moved and nasal discharge, sometimes with bleeding) or other infections of the face, such as orbital or preseptal cellulitis |
CT or MRI done immediately |
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Orbital cellulitis (infection of tissue within and around the eye socket, or orbit)‡ |
Bulging of the eye, eye redness, pain deep within the eye Red, swollen eyelids Sometimes double vision, inability to move the eye in certain directions, pain with eye movement, or loss of vision Usually affecting only one eye Fever Sometimes preceded by symptoms of sinusitis |
CT or MRI |
|
Preseptal (periorbital) cellulitis (infection of the eyelid and the skin and tissues around the front of the eye) |
Swelling and redness around the eye but not bulging of the eye Sometimes pain (usually around the eye) and fever Usually affecting only one eye Normal vision and eye movement Sometimes preceded by a skin infection near the eye |
Sometimes CT or MRI |
Disorders that affect the entire body§ |
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Allergic reactions |
Itching Sometimes allergy symptoms that involve other areas (such as hives, wheezing, or a runny nose) Sometimes in people who have had a previous allergic episode, who have been exposed to an allergen, who tend to have many allergies, or a combination Usually affecting both eyes |
A doctor's examination |
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Disorders that cause swelling throughout the body (such as chronic kidney disease, heart failure, liver failure, and, in pregnant women, preeclampsia) |
Swelling of both eyelids and sometimes the forehead No itching, pain, redness, or other symptoms affecting the eyes Usually swelling of the feet |
Testing for heart, liver, or kidney disorders, depending on which disorder is suspected |
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Hypothyroidism (an underactive thyroid gland) |
A puffy face but no pain Dry, scaly skin and coarse hair Inability to tolerate cold |
Blood tests to evaluate thyroid gland function |
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Graves disease (an overactive thyroid gland caused by an immune problem) |
Bulging eyes, double vision Generally not painful Fast heart rate, anxiety, weight loss |
Blood tests to evaluate thyroid gland function |
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* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. † Although a doctor's examination is always done, it is only mentioned in this column if the diagnosis can sometimes be made only by the doctor's examination, without any testing. ‡ These disorders are rare. § These disorders cause swelling in both eyelids and do not cause redness. CT = computed tomography; MRI = magnetic resonance imaging. |
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Evaluation
The following information can help people decide whether a doctor's evaluation is needed and help them know what to expect during the evaluation.
Warning signs
In people with eyelid swelling, certain symptoms and characteristics are cause for concern. They include
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Fever
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Abnormal bulging of one or both eyes (proptosis)
When to see a doctor
What the doctor does
Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the eyelid swelling and the tests that may need to be done (see table Some Causes and Features of Eyelid Swelling).
Doctors ask
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How long the swelling has been present
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Whether swelling affects the upper and/or lower eyelids in one or both eyes
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Whether any injury (including insect bites) or eye surgery has occurred
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Whether itching, pain, headache, changes in vision, fever, or eye discharge is present
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Whether symptoms affecting other areas of the body are also occurring
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Whether the person has disorders (for example, heart, kidney, or liver disease) or is taking drugs (for example, angiotensin-converting enzyme inhibitors) that are known to cause swelling or has changes in tolerance of cold or heat that might indicate a thyroid disorder
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Whether the person is using any drugs in or around the eye
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Whether there have been any changes in over-the-counter products used on the face or around the eye (for example, new makeup, face creams, or cleansers or new detergent to launder bed linens or towels)
During the physical examination, doctors look for signs of disorders that may affect other parts of the body, but the focus is primarily on the eyes. They look for runny nose and other signs of allergies, toothache or headache, which may indicate a dental or sinus infection, fever, and changes in skin near the eye.
Any eyelid or eye sore is evaluated by using a slit lamp (an instrument that enables a doctor to examine the eye under high magnification). Doctors check the location and color of the swelling and whether the eyelid is tender or warm, whether vision is affected, whether eye muscles are functioning normally, and whether any discharge is present.
Testing
In most cases, doctors can determine the cause of eyelid swelling based on the symptoms and the findings during the physical examination, and no testing is needed. However, if doctors suspect orbital cellulitis or cavernous sinus thrombosis, they immediately do computed tomography (CT) or magnetic resonance imaging (MRI). If a heart, liver, kidney, or thyroid disorder is suspected, doctors do laboratory tests and sometimes various imaging tests.
Treatment
Key Points
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Eyelid swelling may be caused by a disorder of the eye or eyelid or by a disorder elsewhere in the body.
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People with sudden double vision or loss of vision should see a doctor immediately.
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People with fever or a bulging eye should see a doctor within hours if possible.
