Eyelid Swelling

We have selected the following expert medical opinion based on its clarity, reliability and accuracy. Credit: Sourced from the MSD Manual, Consumer Version; authored by Dr Christopher J. Brady (see below). Please refer to your own medical practitioner for a final perspective, assessment or evaluation.

Overview

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:

• 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).

Less common causes

Less common causes of eyelid swelling include disorders that cause generalized body swelling, particularly a type of kidney disease called nephrotic syndrome, bacterial infection of the skin of the eyelids and around the eyes (preseptal or periorbital cellulitis), chronic inflammation of the eyelid margins (blepharitis), and 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).

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 eyelid swelling and the tests that may need to be done (see Table: 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). Doctors check the location and colour 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

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

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

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)
• 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

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

Shingles

• Clusters of fluid-filled blisters on reddened skin, open sores, and significant pain
• Usually affecting only one eye with skin rash adjacent

Stye (hordeolum)

• Redness and pain affecting one eyelid
• Eventually swelling at the edge of the eyelid, sometimes with small, raised, pus-filled bumps
• Insect bite
• Itching, redness, and sometimes a small, raised bump

Cavernous sinus thrombosis (blockage of a vein at the base of the brain by an infected blood clot) – very rare

• 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

Orbital cellulitis (infection of tissue within and around the eye socket, or orbit) – very rare

• 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

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

Disorders that cause swelling throughout the body

• Examples are 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

Hypothyroidism (an underactive thyroid gland)

• A puffy face, but no pain
• Dry, scaly skin and coarse hair
• Inability to tolerate cold

Graves disease (an overactive thyroid gland caused by an immune problem)

• Bulging eyes, double vision
• Generally not painful
• Fast heart rate, anxiety, weight loss

Testing and special investigations

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.

About the author

Dr Christopher J. Brady

MD

Assistant Professor of Ophthalmology, Wilmer Eye Institute, Retina Division, Johns Hopkins University School of Medicine.

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