Merck Manual

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Some Causes and Features of Eyelid Swelling

Some Causes and Features of Eyelid Swelling

Cause

Common Features*

Diagnostic Approach†

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 alone

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 alone

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 alone

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 alone

Conjunctivitis, infectious (pink eye, or inflammation of the conjunctiva, caused by bacteria or a virus)

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 alone

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 alone

Stye (hordeolum)

Redness and pain affecting one eyelid

Eventually swelling at the edge of the eyelid, sometimes with a small, raised, pus-filled bump

A doctor's examination alone

Insect bite

Itching, redness, and sometimes a small, raised bump

A doctor's examination alone

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 of the brain and orbits 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 of the orbits

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

A doctor's examination

Sometimes CT or MRI of the orbits

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 alone

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

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

CT or MRI of the orbits if bulging is severe

* 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 mentioned in this column only if the diagnosis can sometimes be made only by the doctor's examination alone, 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.