Swollen Eyelid

Authored by Dr Mary Lowth, 07 Mar 2018

Patient is a certified member of
The Information Standard

Reviewed by:
Dr John Cox, 07 Mar 2018

A swollen eyelid is a very common symptom, and is usually due to allergy, inflammation, infection or injury. The skin of your eyelid is less than 1 mm thick but it is loose and stretchy, so your eyelid is capable of swelling quite dramatically. This leaflet discusses the reasons why your eyelids might swell, and directs you to more detailed leaflets explaining how to treat these various causes.

Your eyelids are there to protect your 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, so there is NO GAP at the edge of your eyelid down which you can lose a contact lens!

Your upper eyelid includes all of the skin from the lid edge up to your eyebrow whilst your lower eyelid ends where the thicker skin of your cheek begins.

Side View of the Eye

Inflammation (due to allergy, infection, or injury), infection and trauma can all cause swelling of the eyelids. In come 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 red, itchy or painful. Find out more about chalazion cysts.

Eye with upper eyelid chalazion

Cross-section diagram of an eye with chalazion in the upper eyelid

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

External stye

Eye with upper eyelid stye

Cross-section diagram of an eye with a stye in the upper eyelid

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, and they are not usually red or sore. Read more detail about ectropion and entropion.

Eye with ectropion

Cross-section diagram of an eye showing an ectropion

Eye with entropion

Cross-section diagram of an eye showing an 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

Blepharitis

By clubtable (Own work), via Wikimedia Commons

Conjunctivitis

Conjunctivitis is inflammation or infection of the conjunctiva, which is 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 products put on to the eye), 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. See separate leaflets called Allergic Conjunctivitis and Infective Conjunctivitis.

Conjunctivitis

Conjunctivitis

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. You are more likely to develop a skin infection if the integrity of your skin is broken for some reason. This might include an insect bite, an injury, or another condition affecting the skin close to the eye, such as eczema, chickenpox or shingles.

Periorbital cellulitis

Periorbital cellulitis

By Afrodriguezg (Own work), via Wikimedia Commons

Erysipelas

Erysipelas

Sinusitis

Sinusitis is usually caused by 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 separate leaflet called Sinusitis.

Sinuses

sinuses

Allergic eyelid swelling

Allergies occur when your body reacts to a foreign substance (called an allergen) by producing chemicals which cause swelling, redness and itching. In the eyelid the swelling caused by allergic reaction can be quite dramatic, since the eyelid tissue is stretchy and also tends to be quite 'reactive' to allergic stimuli. 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).

Allergic eyelid swelling is often therefore quite dramatic. The eyelids can feel tight and may even be so swollen that you can't open your eyes. 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.

Angio-oedema (sometimes called angio-neurotic oedema)

This is a skin reaction, usually an allergic one, that tends to cause marked skin swelling, sometimes with itching. Mostly, it affects the eyelids and face - less often, the lining of the windpipe (which can make breathing difficult) and the hands and feet.

Angio-oedema

Angio-oedema

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

Angio-oedema is often allergic. Usually the allergy is to something you have eaten, to medication, to something injected into the skin (usually an insect sting), or to something you have touched such as latex. It can sometimes be non-allergic, and be triggered by extremes of temperature, or by infections. Rarely, it can be an inherited condition. See 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 your 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 separate leaflet called Anaphylaxis.

Eyelid irritation

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

Eyelid sunburn

Sunburn of the eyelids happens easily, particularly if you fall asleep lying in the sun. The lids will be swollen, red and sore - but you are likely to have facial sunburn too, which will make the diagnosis obvious. Sunglasses help protect the eyelids against sunburn.

Fluid retention due to other medical conditions

Fluid can gather throughout the body if you are 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, you may notice it first in your eyelids because of the effect this has on your facial appearance.

Fluid retention

Fluid retention - eye area

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 because you are retaining fluid due to 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 you have to be given a lot of fluids quickly (for example, because of dehydration). This is particularly likely if you are unwell and have 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

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 be several weeks after this until the swelling is completely gone. See separate leaflet called Dealing With Eye Injuries.

Head trauma

A small but important addition to the information on black eye is that a significant head injury, causing a fracture of the base of the skull, can cause two swollen black eyes, sometimes called 'raccoon eyes'. See separate leaflet called Head Injuries.

"Raccoon eyes"

Bilateral periorbital ecchymosis

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 you can't see for several days. See separate leaflet called Eyelid Surgery.

Eyelid swelling and bruising also tend to result from other surgery to the nose and lower face. This is because the blood - and the swelling - from these procedures tends to track behind the skin of the face to areas where it can pool easily, 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 emotionally, 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 you might transfer to your eyelids by rubbing your eyes or because you get 'blow-back' from a spray device.

If you suspect a chemical injury to your eyelids or eyes you should wash them as thoroughly as you can. 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 separate leaflet called Dealing with Eye Injuries.

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