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Eyelid Swelling

by Kathryn Colby, MD, PhD

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.

Causes

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.

Common causes

The most common causes are allergic, including

  • Local allergy (contact sensitivity)

  • More widespread allergic reaction (for example, angioedema or allergic rhinitis)

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

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).

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

  • Fever

  • Vision loss

  • Double vision

  • Abnormal bulging of one or both eyes (proptosis)

When to see a doctor

People with warning signs should see a doctor right away. If pain occurs, people usually want to see a doctor within a day or two so that they can start to feel better.

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 swelling and the tests that may need to be done (see Some Causes and Features of Eyelid Swelling).

Doctors ask

  • 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

Cause

Common Features*

Tests

Eyelid disorders

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

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

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

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

Insect bite

Itching, redness, and sometimes a small, raised bump

A doctor's examination

Disorders in and around the orbit

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

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

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

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

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

*Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.

These disorders are rare.

These disorders cause swelling in both eyelids and do not cause redness.

CT = computed tomography; MRI = magnetic resonance imaging.

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

  • Treatment of the cause

The best way to treat eyelid swelling is to treat the disorder that is causing the swelling. There is no specific treatment for the swelling.

Key Points

  • Eyelid swelling may be caused by a disorder of the eye or eyelid or by a disorder elsewhere in the body.

  • People with sudden double vision or loss of vision should see a doctor immediately.

  • People with fever or a bulging eye should see a doctor within hours if possible.

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