Waking up with a heavy, swollen eyelid can be a little disconcerting. If you didn't have an injury, chances are you're staring at yourself in the mirror thinking, What...the...?
There's good news, though. While eyelid swelling can look a little scary, it's not usually cause for concern. "Eyelid swelling is typically benign," says Norman Shedlo, OD, an optometrist with the Eyecare Center of Maryland.
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In response to allergies or infections, cells in the eye will launch a protective immune response that cause the thin tissue of the eye to swell, Dr. Shedlo says.
Knowing what's behind your eye inflammation can help you get the swelling under control and keep the problem from coming back. Here are six of the most common causes and when you should seek medical attention for swollen eyelids.
1. It's an Allergic Reaction
"Most of the time, swelling is the result of a mild allergic reaction to something in the environment," Dr. Shedlo says. Exposure to substances like pollen, dust, ragweed, grass or pet dander can trigger inflammation in the eyes, which can cause swelling or puffiness along with redness, itching, burning or tearing, according to the National Institutes of Health (NIH). You'll probably notice other allergy symptoms too, like a runny or stuffy nose, sneezing, itching or a rash.
Fix it: Managing your allergies can help keep levels of inflammation around your eyes lower, not to mention make you feel more comfortable overall. When swelling strikes, apply cool compresses and use artificial tears to keep your eyes hydrated, recommends the NIH. Oral antihistamines or antihistamine eyedrops can help too.
And if possible, removing the allergen from your environment — for example, sleeping with the windows closed when pollen counts are high —is key to preventing symptoms in the first place.
If you're having symptoms of anaphylaxis (a life-threatening allergic reaction), seek medical attention immediately. Symptoms include severe and rapid swelling of the face, mouth or tongue; difficulty breathing; dizziness or lightheadedness and nausea or vomiting.
2. You Have Pink Eye
The mild eye infection can trigger inflammation, which can cause redness, itchiness, mucus or discharge and some mild swelling, according to the Mayo Clinic.
"Pink eye usually starts in one eye, with symptoms of eye redness and some pain accompanied by some slight lid swelling," Dr. Shedlo says. "After a few days, similar symptoms start in the second eye, usually not to the same degree as experienced in the first eye."
Fix it: Most cases of pink eye are viral and will run their course within a few weeks. In the meantime, you can try pink eye home remedies like applying warm compresses and using artificial tears to ease your discomfort, per the Mayo Clinic. If it goes on longer, see your eye doctor, as it may be a more serious bacterial infection.
3. It's a Bug Bite
Mosquitos don't discriminate between arms, legs or eyelids, so it's possible that one took a nibble near your peeper. You'll know you're likely dealing with a bug bite if the swelling takes the form of a small, raised bump that's red or pink and itchy but not painful, according to Merck Manuals.
Fix it: Ease the itching and take down the swelling by applying a cool compress, per the Mayo Clinic. While hydrocortisone cream or calamine lotion are often recommended for itchy bug bites, you'll want to skip them this time — it's not a good idea to put those near your eyes.
4. You Have a Stye
Styes are painful, red, pus-filled bumps that form on the outside of the eyelid when oil-producing glands around the eyelid become blocked and infected. While they don't typically cause swelling across the entire eye, the area around the stye can be slightly raised, Dr. Shedlo says.
Fix it: There are a number of at-home remedies for styes: Apply a warm compress to your eyelid for 10 to 15 minutes at a time, three to five times per day, to take down the swelling, recommends the American Academy of Ophthalmology (AAO). Using clean fingers, you can also gently massage the area after applying the compress to help encourage the blockage to clear. (Never pop or squeeze the stye, which could cause the infection to spread.)
If the stye doesn't clear up within a few days, it may need to be drained by an eye doctor or treated with antibiotics.
5. It's Shingles
Shingles is best known for causing a red, painful rash. But it's not uncommon for infections to spread to the nerves inside the head and affect parts of the eye, causing swelling, pain, redness, light sensitivity and blurry vision, according to Harvard Health Publishing.
Fix it: Seek medical attention right away if you think you might have shingles affecting your eye. Antiviral medications aren't a cure for the infection, but they can help you heal faster and reduce your chance for complications, including damage to your eyes (scarring from a shingles rash can lead to blindness), according to the Mayo Clinic.
6. You Have a Serious Infection
Though rare, it's possible for an eye injury, bug bite or stye to trigger a serious infection that causes very swollen, red, painful eyelids.
In some cases, bacterial or viral infections can also spread from nearby tissues or blood vessels to the upper or lower eyelid, Dr. Shedlo says.
Fix it: Call your eye doctor right away for severe eye swelling that's accompanied by pain or redness. Serious eye infections typically require oral antibiotics and even hospitalization, Dr. Shedlo says.
When to See a Doctor for Swollen Eyelids
Waking up with a swollen eyelid isn't often an emergency, and most of the time, the swelling will ease up with at-home measures within a day or two. But, according to Dr. Shedlo, you should seek medical attention if:
- Your eyelid is very swollen, red, or painful. "These are signs of an infection, and the patient should be treated with antibiotics as soon as possible," he says.
- The swelling isn't improving or gets worse. Call your eye doctor if your eyelid swelling hasn't improved with at-home measures within one to two weeks, or if it gets worse.
- You suspect the swelling is a sign of anaphylaxis. Anaphylaxis is a serious and potentially life-threatening allergic reaction. It's often marked by severe, rapid swelling of the face, mouth or tongue; trouble breathing; dizziness or lightheadedness and nausea or vomiting.
- National Institutes of Health: "Allergic Conjunctivitis"
- Mayo Clinic: "Pink Eye (Conjunctivitis)"
- Merck Manuals: "Eyelid Swelling"
- Mayo Clinic: "Insect bites and stings: First aid"
- American Academy of Ophthalmology: "What Are Styes and Chalazia?"
- Harvard Health Publishing: "Shingles of the eye can cause lasting vision impairment"
- Harvard Health Publishing: "Shingles"
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.