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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 (see Eyes, Bulging), although a few disorders can cause both.
Eyelid swelling has many causes (see 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.
The most common causes are allergic, including
Swelling of one place in one eyelid is common and is most often caused by a blocked oil gland (chalazion) or a bacterial infection of a hair follicle (stye or hordeolum—see Chalazion and Stye (Hordeolum)).
Less common causes include disorders that cause generalized body swelling, particularly a type of kidney disease called nephrotic syndrome (see Nephrotic Syndrome), bacterial infection of the skin of the eyelids and around the eyes (preseptal or periorbital cellulitis—see Infections of the Orbit (Preseptal Cellulitis), chronic inflammation of the eyelid margins (blepharitis—see Blepharitis), and underactive thyroid gland (hypothyroidism—see Hypothyroidism). An overactive thyroid gland can cause bulging eyeballs but does not cause swollen eyelids.
Rare but dangerous causes are infection within the orbit and around and behind the eye (orbital cellulitis—see Infections of the Orbit (Preseptal Cellulitis) and blockage of a vein at the base of the brain by an infected blood clot (cavernous sinus thrombosis—see Cavernous Sinus Thrombosis).
The following information can help people decide whether a doctor's evaluation is needed and help them know what to expect during the evaluation.
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 swelling and the tests that may need to be done (see Some Causes and Features of Eyelid Swelling).
How long the swelling has been present
Whether swelling affects the upper and/or lower eyelids in one or both eyes
Whether any injury (including insect bites) or eye surgery has occurred
Whether itching, pain, headache, changes in vision, fever, or eye discharge is present
Whether symptoms affecting other areas of the body are also occurring
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
Whether the person is using any drugs in or around the eye
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—see Figure: What Is a Slit Lamp?). 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.
Some Causes and Features of Eyelid Swelling
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.
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