Swollen eyelid

Swollen eyelid causes

Inflammation (due to allergy, infection, or injury), infection and trauma can all cause swelling of the eyelids. In some cases swelling of the eyelid may be the only symptom but in others the eyelid is also likely to be red, itchy, gritty or sore.

Chalazion

A chalazion causes a lump or localised swelling in the eyelid, although it can cause the whole of the eyelid to swell, particularly if it becomes inflamed or infected.

A chalazion occurs when one of the Meibomian (or tarsal) glands in the eyelid becomes blocked, resulting in a small (2-8 mm) fluid-filled swelling (cyst). A chalazion is more common on the upper eyelid. It is not usually itchy or painful but it can be red or darker than surrounding skin. Find out more about chalazion cysts.

Chalazion

jd, Public domain, via Wikimedia Commons

Eye with upper eyelid chalazion

Stye

A stye is a common painful eyelid problem, where a small infection forms at the base of an eyelash, which becomes swollen and red, along with the surrounding edge of the eyelid.

It looks like a pus-filled spot. However, the infection and inflammation often spread back into the lid to make the whole eyelid swollen. It is usually red, as well as swollen, and can sometimes feel slightly sore. Learn more about stye infections.

External stye

By Andre Riemann, Public domain, via Wikimedia Commons

Eye with upper eyelid stye

Ectropion and entropion

An ectropion occurs when part or all of the lower eyelid turns outwards away from the eye. An entropion occurs where the lower eyelid turns in towards the eye, causing the eyelashes to rub against the front of the eye.

The eyelids can occasionally become inflamed and a little swollen, although this is not usually dramatic. Read more detail about ectropion and entropion.

Eye with ectropion

Eye with entropion

Blepharitis

Blepharitis means inflammation of the eyelids. It makes the eyes and eyelids feel sore and gritty. They are often puffy, pink-red, and a little swollen, particularly along the lid edges.

Blepharitis can be a troublesome and recurring condition, sometimes associated with other skin conditions such as rosacea and seborrhoeic dermatitis. Find out more about blepharitis.

Blepharitis

By clubtable (Own work), via Wikimedia Commons

Conjunctivitis (pink eye)

Conjunctivitis is inflammation or infection of the conjunctiva (the smooth, shiny, translucent membrane that covers the white of the eye (sclera) and the underside of the eyelids).

It can be caused by allergies and sensitivities (for example, to make-up), or by infection.

The main symptoms of conjunctivitis are redness of the eye, and a feeling of grittiness and mild soreness. As conjunctivitis affects the underside of the eyelids, it can make the eyelids puffy and a little red, either because the infection spreads into the eyelid or because the eyelid becomes inflamed or reacts in an allergic manner due to the infection. There may be some pus, or the eye may just be watery.

See the separate leaflets called Allergic conjunctivitis and Infective conjunctivitis.

Bacterial conjunctivitis

By Gzzz, CC BY-SA 4.0, via Wikimedia Commons

Eyelid skin infection

Any infection in the skin of the eyelid will tend to cause marked swelling, with redness, itching and soreness. Infection can also spread to the eyelids from other parts of the face.

Infections of the skin include cellulitis, impetigo and erysipelas, which are different types of skin infection affecting different levels of the skin. A skin infection is more likely if the integrity of the skin is broken for some reason. This might include a condition affecting the skin close to the eye, such as eczema, chickenpox or shingles.

Periorbital cellulitis

By Afrodriguezg (Own work), via Wikimedia Commons

Sinusitis

Sinusitis is usually caused by a bacterial or viral infection, although it may also be caused by allergy. Sinusitis affecting the sinuses just beneath the eyes can cause puffiness around the eyes, affecting the eyelids. The eyelids are not usually red, sore or itchy.

See the separate leaflet called Sinusitis.

Sinuses

Allergic eyelid swelling

Allergies occur when the body reacts to a foreign substance (called an allergen) by producing chemicals which cause swelling, redness and itching.

Eyelid swelling caused by an allergic reaction can be significant, since the eyelid tissue is stretchy and also tends to be quite 'reactive' to allergic stimuli. Allergic eyelid swelling is often therefore quite dramatic. The eyelids can feel tight and may even be so swollen that the eyes can't open. Over time the extra fluid in the eyelids tends to drop downwards through the action of gravity to fill the area of the lower lid down to the top of the cheek, causing large 'bags' under the eyes. Sometimes overnight, when lying on one's side, gravity results in swelling of one eyelid even though the trigger is an allergen such as pollen.

Eyelids can react in an allergic manner to various triggers, including:

• Naturally occurring substances such as pollens, pet hair and organic dust.

• Chemicals such as shampoo, make-up, eye drops and contact lens solution.

• Infectious agents such as viruses and bacteria (which can therefore sometimes cause infection AND allergy at the same time).

Angio-oedema

This is sometimes known as angio-neurotic oedema and is a skin reaction, usually caused by an allergy, that tends to cause marked skin swelling, sometimes with itching. Mostly, it affects the eyelids and face, and sometimes the lining of the windpipe (which can make breathing difficult) and the hands and feet.

Angio-oedema

By James Heilman, MD, Own work), via Wikimedia Commons

It can sometimes be non-allergic, and be triggered by extremes of temperature, or by infections. Rarely, it can be an inherited condition. See the separate leaflet called Angio-oedema.

Anaphylaxis

Anaphylaxis, or anaphylactic shock, is a medical emergency. It is an extreme and generalised allergic reaction affecting most of the bodily systems. It can include dramatic eyelid swelling, which can be an early warning sign although it is not the most important symptom.

Anaphylaxis can cause faintness, breathing difficulties and collapse, and anaphylaxis tends to come on quickly, the full effects sometimes developing over a few minutes and usually within an hour of symptoms beginning.

Occasionally, anaphylactic reactions to food can come on more than an hour after eating the food, but this is not the usual pattern. If you have marked eyelid swelling but have no other obvious developing symptoms, you are unlikely to be developing anaphylaxis. See the separate leaflet called Anaphylaxis.

Eyelid irritation

The eyelids can become puffy, swollen and red because they are irritated by grit, dust or bonfire or cigarette smoke, without a true allergic reaction. The eyes are also usually red and watery too.

Eyelid sunburn

Sunburn of the eyelids happens easily, particularly if falling asleep lying in the sun. The lids are swollen, red and sore. Sunglasses and the use of sun cream help to protect the eyelids against sunburn.

Fluid retention due to other medical conditions

Fluid can gather throughout the body when retaining fluid - a condition called oedema. Whilst fluid retention is often noticeable in the fingers, around the lips and lower face, around the feet and ankles, and in the lower part of the back, it may also be noticed in the eyelids.

Fluid retention

By Klaus D Peter (Own work), via Wikimedia Commons

Fluid retention and tissue swelling of this type can occur because of generalised allergic reactions (see below) or due to retaining fluid because of medication or to a medical condition such as heart failure or pre-eclampsia (a condition related to pregnancy).

Intravenous fluids given as part of medical treatment can sometimes cause facial and eyelid swelling, particularly if needing to be given a lot of fluids quickly (for example, because of dehydration). This is particularly likely in someone who is unwell and has been lying flat, so that the extra fluid has tended to gather in the face and eyelids and has not yet dispersed evenly. However, generalised swelling due to medical treatment is more often an allergic reaction than an 'expected' reaction of this sort.

Eyelid trauma and black eye

Any direct injury to the eyelid will tend to make it swell and bruise, and the swelling is often very much worse the next day. A black eye can be caused by direct injury to the eyelid, but commonly also results from a blow to the nose or forehead. A blow to the nose often results in black eyes on both sides - and cosmetic surgery to the nose or face can have the same result.

Black eye

By Pavel Ševela (Own work), via Wikimedia Commons

The looseness of the eyelid skin means that blood can easily pool in this area after injury - and where blood pools, swelling will follow. As the black eye heals, the swelling gradually decreases, and the bruise goes through several stages before fading. It can take several weeks after this for the swelling to fully settle. See the separate leaflet called Dealing with eye injuries.

Head trauma

A significant head injury resulting in a fracture of the base of the skull, can cause two swollen black eyes, sometimes called 'raccoon eyes'. See the separate leaflet called Head injuries.

"Raccoon eyes"

By Marion County Sheriff's Office, via Wikimedia Commons

Facial, nose or eyelid surgery

Eyelid surgery, sometimes done to correct entropion or ectropion (see above), or for cosmetic reasons, is an example of intentional injury to the eyelids which causes bruising and swelling. The eyelids can be so swollen after eyelid procedures that the eyes are unable to open for several days.

Eyelid swelling and bruising often also results from other surgery to the nose and lower face. This is because the blood from these procedures tends to track behind the skin of the face to areas where it can pool easily causing swelling, and this includes the eyelids. The bruising and swelling can be dramatic and can take several weeks to settle down completely.

After crying

Most people will have noticed eyelid swelling after crying, particularly if this is prolonged. This occurs because the eyelids tend to absorb some of the extra tears, leading them to become temporarily swollen.

Chemical irritation and burns

Some chemicals can irritate the eyelids, causing them to swell. This can occur with some make-up products and soaps. Many people will be familiar with the eyelid irritation and swelling caused by chlorine in swimming pools. Tear gas, sometimes used to dispel crowds, causes swelling and inflammation of the eyelids, although sore and tearful eyes are the main symptoms of exposure.

Some chemicals can cause serious injury to the eyelids, beginning with swelling and pain. The causes include some everyday household chemicals such as oven cleaners, which contain strong alkali, and which might be transferred to the eyelids by rubbing the eyes.

If a chemical injury to your eyelids or eyes is suspected, they should be washed as thoroughly as possible. Run 20 litres of water over them directly from the tap, keeping running water on your open eye or eyes for 5-10 minutes, before seeking medical advice. See the separate leaflet called Dealing with eye injuries.

Remedies and treatment for a swollen eyelid

The treatment will largely depend on the cause. Further information is available by following the links to specific leaflets.

In general, treatments may include some or all of:

• Cleaning the area (sometimes with diluted baby shampoo).

• Using a warm wet compress.

• Artificial tears (for dry eyes).

• Eye drops/ointment (for allergic or bacterial conjunctivitis).

• Oral antibiotics (for orbital cellulitis, though this often needs hospital admission for intravenous antibiotics).

• Oral antihistamines (for allergies).

• Steroid nasal spray (for hay fever or other allergies).

Patient picks for Eyelid problems

Eye health

Entropion

An entropion occurs where the eyelid turns towards the eye. The eyelashes then rub against the front of the eye (cornea). Irritation, pain and watering of the eye are the main symptoms. Taping the eyelid to the cheek, lubricant eye ointment and sometimes botulinum toxin injections help to control symptoms. People often require surgery if the problem persists.

by Dr Colin Tidy, MRCGP

When to see a doctor about a swollen eyelid

Many of the conditions discussed here are self-limiting, or can be treated with medication bought over the counter.

Medical advice should be sought if:

• Vision is significantly impaired (more than just being blurry due to a watery eye and recovering fully when you wipe your eyes)

• There is a deep pain in the centre of the eye (rather than just a gritty feeling on the surface)

• The whole area around the eye is red and swollen, as that might indicate periorbital cellulitis.

Usually a pharmacist is usually a sensible first port of call - they are well trained to deal with these issues and will advise if it is something that can be treated over the counter.

What are eyelids?

Side View of the Eye

Eyelids are there to protect the eyes and to keep the surface of the eye (particularly the cornea, which is the clear part of the eye over the iris and pupil) from drying out.

Each eyelid consists of thin skin (with some pads of fatty tissue), muscle and a lid-shaped piece of thick fibrous material called the tarsal plate. These tarsal plates contain Meibomian glands which produce oily material which helps keep the eye and eyelid lubricated.

The inside of each eyelid is lined by an inner layer of conjunctiva, a smooth translucent membrane which covers the inner surface of the eyelids and the outer surface of the white of the eye.

The conjunctiva then reflects back on to the eye. The upper eyelid includes all of the skin from the lid edge up to the eyebrow whilst your lower eyelid ends where the thicker skin of the cheek begins.