Waking up to a child with thick, puffy eyelids is alarming. The cause can range from a mild allergy to an infection that needs quick treatment, and a few clues help sort out which is more likely.
Why It Happens
Eyelid skin is thin and loose, so a small amount of inflammation or fluid makes it swell. Three causes are common. Allergic swelling follows exposure to pollen, dust or animal dander and is marked by itching. A stye is a gland in the eyelid infected by bacteria and appears as a single painful, red bump. Preseptal (periorbital) cellulitis is a bacterial infection of the eyelid and tissue in front of the eye, and risk factors include a recent injury near the eye or a sinus infection. Orbital cellulitis, in which infection reaches the tissues behind the eye, is far more serious.
How It Differs by Age and Stage
A pediatric approach summary suggests that swelling in both eyes without other major features points toward allergy, while swelling in one eye with a fever calls for a workup for cellulitis. Allergic swelling almost always involves both eyes, itches a lot and produces clear, watery tears. Infection more often shows a red, warm, tender eyelid on one side, sometimes with fever. In younger children things can change within hours, so check again later in the day.
What to Do at Home
If both eyes are swollen and itchy with no fever, avoid the likely trigger and lay a clean cool, damp cloth over the eyes. Wash hands and keep nails short so your child rubs less. For a single tender lump that looks like a stye, a warm compress a few times a day can be tried, and the bump should not be squeezed. In every case, note when you first saw the swelling, redness and fever, which helps the clinician. Do not start leftover eye drops, ointments or antibiotics on your own. If preseptal cellulitis is diagnosed, it is usually treated with oral antibiotics, and guidance says to return if redness, swelling or fever do not improve within 24 hours of starting treatment or a new fever appears.
Common Misunderstandings
One is that every swollen eye is an allergy; one-sided swelling with pain or fever can be infection. Another is that swelling that comes and goes is harmless. Swelling lasting more than 3 days or returning often deserves an exam. A third is judging by appearance alone; the key signs of deeper infection are pain with eye movement and vision changes, which cannot be seen from the outside. A fourth is using whatever eye drops are at home.
When to Seek Care
See a pediatrician or eye doctor the same day if one eyelid is swollen with fever, or the area is red, warm and tender. Go to the emergency room right away if your child has pain when moving the eye or cannot move it well, double vision or reduced vision, a bulging eye, rapidly worsening redness or swelling, or looks increasingly ill, since these suggest orbital cellulitis. Swelling of the lips, tongue or face with trouble breathing or spreading hives may be a severe allergic reaction and needs emergency care immediately. This information is based on U.S. and international sources; if you live elsewhere, check with a local pediatrician. This information isn’t a diagnostic tool and doesn’t replace advice from a medical professional.