Puffy Eyes

What is it?

Periorbital edema is swelling of the soft tissues surrounding the eyes. The periorbital area is particularly prone to fluid accumulation because of its loose connective tissue. The most common causes are benign: insufficient sleep causes fluid redistribution to the periorbital space, while allergic conjunctivitis causes bilateral itchy, watery eyes with periorbital swelling. Contact dermatitis from cosmetics or topical medications causes unilateral or bilateral swelling with erythema. Angioedema (histamine-mediated or hereditary) is a more serious cause — rapid-onset deep swelling, potentially involving the lips and throat. Systemic causes include hypothyroidism (myxedema), nephrotic syndrome, and heart failure.

Common causes

When to see a doctor

• 1Sudden severe periorbital swelling with throat tightness or difficulty breathing — angioedema emergency
• 2Unilateral eye swelling with warmth, tenderness, and fever — periorbital or orbital cellulitis
• 3Eye swelling with proptosis (eye bulging) — possible orbital cellulitis or Graves' ophthalmopathy
• 4Persistent bilateral periorbital edema in the morning that improves through the day — evaluate for hypothyroidism or renal disease
• 5Periorbital swelling with generalized edema, foamy urine — screen for nephrotic syndrome

What you can do

• ✓Apply a cold compress to the eyes for 10 minutes in the morning
• ✓Elevate the head of bed by 2–4 inches to reduce morning fluid accumulation
• ✓Reduce dietary sodium and alcohol — both promote fluid retention
• ✓Ensure 7–9 hours of sleep per night — fatigue is among the most common causes
• ✓Chilled caffeinated tea bags applied to the eyes cause mild vasoconstriction and reduce swelling

Conditions that cause this symptom

Medications that may help

Treatment depends on the underlying cause. Always consult your provider before starting any medication.

Frequently asked questions