Tuesday, September 2, 2014

Swollen Eyelids: Causes, Treatments, and When to Worry

There are many causes of swollen eyelids in kids (and adults). The good news is that the most common ones are usually not serious. Some swellings herald warning though and should be properly evaluated and treated by a doctor. Warning signs include vision changes, pain, protrusion of the eye, fever, difficulty breathing, abnormal eye movements (or loss of movement), foreign body that cannot be removed, or signs of anaphylaxis (swollen tongue or throat, difficulty breathing, hives). Any warning signs deserve prompt medical attention.

swollen eyelids, eyes, bug bites, cellulitis

Allergies can make the eyelids puffy due to the histamine reaction. This is usually accompanied by itching, red eyes that are watery. Treatment involves either oral allergy medicines, topical allergy medicine (eye drops) or a combination of both. Washing the face, hair, and eyes after exposure to allergen can also be an important part of treatment.

Anaphylaxis is a more serious allergic reaction. It involves swelling of the eyelids, throat, and airways. This is a medical emergency. If epinephrine is available, use it. Call 911.

Blepharitis is an inflammation of the eyelids that can cause swollen lids, often with flaky eyelid skin and loss of the lashes. This chronic condition should be managed by an eye care specialist.

Bug bites are the most common cause of swollen eyelids we see in our office. Usually there is a known exposure to insects and there may be other bug bites on the body. Bug bites on the eyelid tend to itch rather than hurt despite the significant swelling they produce. There should be no fever or other signs of illness. The eyeball should move freely in the socket. (See "orbital cellulitis" below.) Treatment of bug bites involves cool compresses and oral antihistamines. Occasionally oral steroids are required for significant swelling, but they require a prescription. If the swelling is concerning to you or your child, bring him in to be seen.

Conjunctivitis, also known as pink eye, causes inflammation of the surface of the eye ball and sometimes a puffy appearance to the eye lids. It can be from bacteria, virus, or allergies. Bacterial conjunctivitis causes the whites of the eyes to look red and includes a yellow discharge from the eye. Viral conjunctivitis causes the white of the eye to look red, but there is no yellow discharge. Allergic conjunctivitis is described above under "allergies." If unsure which type your child has, or if it is probably bacterial, see your doctor.

Contact lenses can contribute to swollen eyes if they are dirty or damaged. See your eye doctor in this case.

Crying can cause the eye lids to become puffy. The lacrimal glands produce an overflow of tears, so the fine tissues around the eyes absorb the fluid, causing them to appear swollen. This is compounded by the autonomic nervous system increasing blood flow to the face during times of strong emotion and rubbing the eyes to wipe away the tears. This cause of swelling is short lived. Cool compresses and avoidance of rubbing can help decrease the swelling.

Graves' disease can cause swelling of the eyelids and protruding eyes. Sometimes a drooping eyelid or double vision occurs. It is caused by thyroid problems, which also can cause problems with appetite, fatigue, heat intolerance, and more. These symptoms should be evaluated by a doctor.

Kidney problems can lead to fluid retention. If the eyes are puffy along with puffiness of the ankles or swelling of the abdomen, kidney problems should be considered. Children can develop this suddenly from infections, like certain diarrheal illnesses or Strep throat. The urine may look tea colored or like it has blood in it. This is a medical emergency and you should seek care immediately.

Sinus infections can cause puffy eyelids. Congestion, runny nose, headache, postnasal drip, and cough are typical symptoms. See your doctor if you suspect sinusitis.

Styes look like a swelling at the edge of the eyelid, often red or pink with a small white central area. It is caused by a blockage in one of the small glands in the eyelid. Another swelling from blockage of oil glands of the eyelid is a chalazion. Both a stye and a chalazion can start as painful bumps, but after a few days they no longer hurt. They can cause the whole eyelid to swell. Applying warm packs to the area several times per day often helps treat styes. Chalazions more often need to see an ophthalmologist for treatment. If a stye persists beyond a few months or the lid swells to cover the pupil, see your doctor.

Trauma of the eye or nose, like any trauma, can cause swelling. A broken nose can cause swelling and bruising to the eyelids. Any significant trauma to the eye or nose should be seen by a doctor. Symptoms may include vision changes, chemical exposure, foreign body in the eye, blood in the eye, severe pain, or nausea or vomiting after injury.

Ocular herpes is an infection of the eye by the herpes virus. (Not all herpes infections are sexually transmitted!) It can appear initially like a blister or cluster of blisters near the eye. It can lead to permanent damage to the eye, so prompt care by an ophthalmologist is important.

Orbital cellulitis is a potentially serious infection of the eyelids. The infection can extend behind the eyes, causing meningitis. It is suspected when there is painful swelling of the upper and lower eyelids, fever, bulging eyes, vision problems, and pain with eye movement (or inability to move the eyes). This is a medical emergency and if suspected, prompt medical attention is warranted. Treatment involves iv antibiotics. To assess the extent of swelling or to differentiate between pre-septal cellulitis (which is not into the deep tissues) and orbital cellulitis, imaging is often done.

Ptosis, or drooping of the eyelid, can look like a swollen lid. There are many causes and this should be evaluated by a doctor.

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