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Eye Swelling

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Definition

  • Swelling of eyelids or area around the eye
  • No redness of white part of the eye (sclera)
  • No yellow or green discharge (pus)
  • Swelling is not caused by an eye injury. If so, see that guide.

Eye Swelling Scale

  • Mild: eyelid is puffy, but can open eyes like normal
  • Moderate: more than puffy, but eyes still open some
  • Severe: eyelids swollen shut or almost shut

Causes of Eye Swelling on One Side

  • Rubbing the Eye. Rubbing from any cause will make the eyelids puffy. Often, it starts from getting an irritant in the eye. Young children often touch their eyes with dirty hands. They also may get food in the eye.
  • Insect Bite near the eye. A reaction to the insect's spit causes swelling. The loose eye tissues swell easily. The most common bite is from a mosquito.
  • Contact Dermatitis near the eye. An example is poison ivy.
  • Injury near the eye. Can cause a bruise and swelling.
  • Sty. A minor infection of an eyelash.
  • Dacryocystitis. An infection of the tear sac in the corner of the eye.
  • Ethmoid Sinus Infection (serious). This causes swelling and redness of the eyelid. The ethmoid sinus is behind the eye.
  • Periorbital Cellulitis (serious). A bacterial infection of the eyelid. Caused by spread from nearby infected wound or insect bite. The eyelid is very red and usually painful to touch.

Causes of Eye Swelling on Both Sides

  • Allergic Conjunctivitis. Itchy pink eyes from pollen or pet dander.
  • Viral Conjunctivitis. The main symptom is red eyes with a cold.
  • Bacterial Conjunctivitis. The main symptom is yellow pus in the eye or eyes. Eyelids may be matted shut.
  • Edema (serious). Edema is retained fluid within body tissues. Edema fluid first appears as swelling of the feet due to gravity. Edema fluid also occurs around both eyes after lying down. It's caused by kidney, heart or liver failure.
  • Anaphylaxis (very serious). A severe life-threatening allergic reaction. Triggered by foods, drugs and bee stings. Serious symptoms such as trouble breathing or swallowing occur. Hives are almost always present.

Swelling of Eye: Clues to the Cause

  • Swelling of 1 eye is often due to an insect bite. Mosquito bites are a common cause. It can also be from an irritant (e.g. food) transferred to the eye by the hands.
  • Suspect mosquito bites if there are bites on other parts of the body. Insect bites of the upper face can cause the eyelid to swell. This can last for a few days. With insect bites, the swelling can be pink as well as large. Large swelling is common for ages 1-5 years.
  • Swelling of both eyes is usually due to pollen that's airborne. This includes tree, grass or weed pollen. These pollens float in the air and can travel hundreds of miles. Itching also makes the swelling worse.
  • Swelling of the face is usually due to allergic reactions to swallowed substances. Examples are foods or medicines. May be part of a severe allergic reaction.
  • Allergic reactions to antibiotic eyedrops can cause severe swelling of both eyes.
  • Swollen eyelids from insect bites, pollens or other allergies are itchy.
  • Swollen eyelids from eyelid infections are painful and tender to the touch.
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When To Call

Call 911 Now

  • You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

  • Severe swelling (shut or almost) of both eyes
  • Severe swelling (shut or almost) of one eye with fever
  • Eyelid (outer) is very red and swollen with fever
  • Loss of vision or double vision
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Fever
  • Severe swelling (shut or almost) of one eye without fever
  • Eyelid (outer) is very red and swollen without fever
  • Eyelid is painful or very tender
  • Swollen ankles or feet
  • Sinus pain (not just congestion) around cheekbone or eyes
  • Moderate swelling with the eye open a little. Exception: due to a mosquito bite.
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Mild swelling (puffy eye or eyes) lasts more than 3 days
  • Eyelid swelling is a chronic problem and not explained
  • You have other questions or concerns

Self Care at Home

  • Eyelid swelling from suspected bug bite
  • Eyelid swelling without a cause
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Care Advice

Treatment for Eyelid Swelling from Suspected Bug Bite

What You Should Know About Eye Swelling from Bug Bites:

  • Mosquito bites are very common.
  • Bites to the face can cause severe swelling around the eye. Reason: the tissues around the eye are loose.
  • Size is larger in young children.
  • The swelling is harmless.
  • Here is some care advice that should help.

Cold Pack For Swelling:

  • Apply ice wrapped in a wet washcloth to the eye for 20 minutes.

Allergy Medicine for Itching:

  • If itching becomes severe, give an allergy medicine, such as Benadryl.
  • No prescription is needed. Age limit: 1 and older.
  • If needed longer than a few days, switch to a long-acting antihistamine, such as Zyrtec. Age limit: 2 and older.

Eye Drops:

  • The eyelid swelling often will improve after a cold pack or Benadryl is given.
  • Age 6 years and older. For eyelid swelling that interferes with vision after cold pack, use some eye drops. Use a long-acting vasoconstrictor eye drop (such as Visine). No prescription is needed.
  • Dose: 1 drop every 8 to 12 hours as needed for 1 or 2 days.
  • Do not use for over 5 days. Reason: will cause red eyes from rebound effect.

What to Expect:

  • Itching may last for 2 days.
  • Pinkness or redness lasts about 3 days.
  • The eye may be puffy for up to 7 days.

Call Your Doctor If:

  • Swelling lasts over 7 days
  • Redness lasts over 3 days
  • Becomes painful to touch
  • You think your child needs to be seen
  • Your child becomes worse

Treatment for Eyelid Swelling Without a Cause

What You Should Know about Eyelid Swelling Without a Cause:

  • Most eye swelling without a cause is from rubbing the eyes.
  • The eye tissues are loose and easily swell.
  • The rubbing is often from getting an irritant in the eye. It's often seen in young children who touch their eyes with dirty hands. While eating, some children even get food in their eyes.
  • This type of swelling to an irritant can be treated at home.
  • Here is some care advice that should help.

Cold Pack For Swelling:

  • Apply ice wrapped in a wet washcloth to the eye for 20 minutes.

Allergy Medicine for Itching:

  • If itching becomes severe, give an allergy medicine, such as Benadryl.
  • No prescription is needed. Age limit: 1 and older.
  • If needed longer than a few days, switch to a long-acting antihistamine, such as Zyrtec. Age limit: 2 and older.

Eye Drops:

  • The eyelid swelling often will improve after a cold pack or Benadryl is given.
  • Age 6 years and older. For eyelid swelling that interferes with vision after cold pack, use some eye drops. Use a long-acting vasoconstrictor eye drop (such as Visine). No prescription is needed.
  • Dose: 1 drop every 8 to 12 hours as needed for 1 or 2 days.
  • Do not use for over 5 days. Reason: will cause red eyes from rebound effect.

What to Expect:

  • The itching should stop after the irritant is washed out of the eye. This may take up to a few hours.
  • The swelling will clear 24 hours after the child stops rubbing the eye.

Call Your Doctor If:

  • Swelling lasts over 3 days
  • Eyelid becomes red and painful to the touch
  • You think your child needs to be seen
  • Your child becomes worse

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Eye Anatomy

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Source: Self Care Decisions, LLC 2023
Self Care Decisions, LLC 2023

Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2024. Schmitt Pediatric Guidelines LLC.
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