What Your Puffy Eyes Are Trying to Tell You

Eye puffiness, medically termed periorbital edema, may result from harmless factors like sleep deprivation or too much sodium intake, but can also indicate health issues such as diabetes or thyroid problems. Don't ignore it if it persists—consult a specialist to ensure your vision and health aren’t at risk.

Symptoms of Swollen Eyes

Periorbital edema refers to the temporary swelling of tissues around the eyes ("peri" meaning around and "orbital" referring to the eyeball) due to fluid retention.

Symptoms of periorbital edema can vary but often include:

• Swelling and puffiness: Around the eyes

• Eye redness: Redness signaling irritation

• Excessive tearing: More tearing than usual

• Dark circles: Under the eyes

• Eye itchiness: Itchy feeling in or around the eyes

• Visible sclera swelling: Swelling of the white of the eye

• Eye pain: Could be constant or when moving the eyes

• Vision changes: Blurred vision or other changes

• Light sensitivity: Discomfort with light exposure

• Creamy discharge: Oozing from the eyes

Your symptoms can suggest the cause, such as if the swelling is:

• Acute vs. chronic: Sudden and severe, or persistent and recurring

• Bilateral vs. unilateral: Affecting both eyes or just one

Everyday Reasons Your Eyes Might Be Puffy 

The cause of your puffy eyes might be obvious, such as when you've been crying or develop hay fever. But there are also times when the cause of eye swelling is not so clear.

Lack of Sleep

When you stay up late or don't get enough sleep, it disrupts your normal breathing patterns during sleep. This can lead to sleep-disordered breathing, where abnormal breathing lowers blood oxygen levels.

To compensate for the loss of oxygen, blood vessels will dilate (widen) to deliver more blood to tissues. The dilation, in turn, can cause fluids to leak into surrounding tissues. When the delicate tissues of the lower eyelid are involved, puffiness can ensue.

Sleep apnea, characterized by sleep-disordered breathing, can do the same, making a person not only feel sleepier but look tired during the day.

Diet

Sodium is one of several minerals that regulate the movement of water in and out of cells. When you consume the right amount of sodium in the form of salt, the balance between the water inside and outside of a cell is maintained.

On the other hand, when you eat too much salt, water is not only retained in cells but also starts to accumulate. This is what water retention means.

Sodium is found in high concentration in foods that are both salty and unsalty, including:

• Processed or packaged foods

• Fast food

• Alcoholic drinks

• Carbonated beverages

• Sauces and seasonings

• Lunch meat

• Soups

Limiting foods with a high sodium content may help lower the risk of eye puffiness.

Why Crying Causes Puffy Eyes

For much the same reason that eating too much salt can cause puffy eyes, the salt in tears can cause fluid retention around the eyes when you cry. The more you cry, the worse the swelling can become.

Allergies

Allergies can also cause puffy eyes. These not only include seasonal allergies (hay fever) but also allergies to foods and medications.

Allergies result when exposure to an allergy-causing substance (allergen) triggers the release of histamine into the bloodstream. Histamine is a chemical that induces inflammation, causing blood vessels to swell and leak fluids into surrounding tissues.

When the eyes and nasal passages are involved, puffiness and sneezing can occur. Nasal congestion makes things worse by increasing fluid drainage into surrounding tissues, including around the eyes.

Some of the more common allergens include:

• Dust mites

• Mold

• Pet dander

• Pollen

• Tree nuts

• Peanuts

• Wheat

• Milk

• Soy

• Shellfish

In most cases, these allergies will cause bilateral swelling. However, a bug bite or an allergy-related condition called contact dermatitis can cause unilateral swelling, leaving one eye swollen and the other one not.

Normal Aging

As we age, many parts of our bodies lose muscle tone, firmness, and elasticity. The eyes are no exception.

In most people, the production of collagen (the primary building block of skin, muscles, bones, and connective tissues) starts to dwindle by the late 20s to early 30s, thereafter decreasing at a rate of 1%-1.5% per year.

This not only causes the skin under the eyes to become thin but also undermines the collagen matrix underneath the skin, allowing fat to move into the space. This ultimately results in lower eyelid fat prolapse ("baggy eyes").

With baggy eyes, the laxity and porousness of the skin make them more vulnerable to fluid retention. The accumulated fat beneath the eyes can also readily absorb and retain fluid.

Genetics

It is more than possible to have inherited a tendency toward puffy eyes and dark circles from your parents. If there are several people in your family with puffy eyes, this could even be a sign of a genetic condition that causes puffy eyes.

In rare instances, an inherited disorder like hereditary angioneurotic edema can cause recurrent episodes of deep tissue swelling (called angioedema). The most commonly affected areas are the face, arms, legs, and airways.

More commonly, genetics is likely to affect how your skin ages and how slowly or quickly collagen production diminishes over time. If, for example, one or both of your parents had baggy eyes in their 20s or 30s, you might have the same at that age.

Health Conditions That Cause Swollen Eyes

There are many medical conditions in which puffy eyes are common. Some of these cause localized inflammation around the eyes, while others cause metabolic changes that affect the fluid balance throughout the body.

Medical conditions that can cause periorbital edema include:

• Blepharitis: Inflammation of the eyelids

• Chalazion: A clogged gland at the base of the eyelashes

• Chronic kidney disease: The gradual loss of kidney function

• Conjunctivitis: Also known as "pink eye"

• Diabetic retinopathy: An eye complication of diabetes

• Keratitis: Inflammation of the clear part of the eye, called the cornea

• Optic neuritis: Inflammation of the optic nerve

• Orbital cellulitis: A severe infection of tissues surrounding the eyeball

• Stye: A minor infection of an eyelash

• Thyroid eye disease: An autoimmune disease that causes eye bulging

• Uveitis: Inflammation of the pigmented layer of the eye, called the uvea

Swollen Eyes as a Drug Side Effect

Certain drugs can also cause eye puffiness and the accumulation of fluid under the eye, including:

• Aczone (dapsone)

• Allopurinol

• Antiseizure medications (ASMs)

• Imuran (azathioprine)

• Flagyl (metronidazole)

• Gleevec (imatinib mesylate)

• Minocycline

• Nonsteroidal anti-inflammatory drugs (NSAIDs)

• Sulfonamides

• Plavix (clopidogrel)

Diagnosing the Cause of Puffy Eyes

Puffy eyes can often be diagnosed through a physical exam and a review of your medical history. Things like hay fever and conjunctivitis ("pink eye") are often self-evident, particularly if you have risk factors for the conditions.

At other times, an extensive investigation may be needed if the symptoms are sudden, severe, or recurrent. This is especially true if the eye puffiness is unilateral and occurs for no apparent reason.

Healthcare providers often suspect certain conditions based on how they typically present themselves. This may start with whether they are typically bilateral or unilateral and whether the symptoms are typically acute or chronic. There are no hard and fast rules.

Depending on the suspected cause, various tests and procedures may be ordered, including:

• Complete blood count (CBC): A blood test that can help detect infection

• Allergy tests: Including blood tests and skin prick tests

• Thyroid blood test: Used to check for high or low thyroid hormones

• Kidney function tests: Blood and urine tests that check for chronic kidney disease

• Eye swab culture: Used to identify infections with a swab of eye fluid

• Slit lamp: An instrument that looks inside the eye with a high-energy beam of light

• Imaging tests: Including computed tomography (CT) and magnetic resonance imaging (MRI) scans

How Are Puffy Eyes Treated?

Puffy eyes are often harmless and don't require treatment, but there are ways you can minimize swelling and improve the appearance of your eyes. Depending on the cause, you may be able to get rid of puffy eyes completely.

At-Home Remedies and Lifestyle Changes

There are a few simple strategies and products you can try at home to relieve swollen eyes, including:

• Using a cool compress: Wet a washcloth with cool water and place it over your eyes for several minutes while sitting upright.

• Avoiding allergy triggers: This includes checking local pollen and mold levels on the news and staying indoors when the counts are high. Vacuum and dust your home to limit your exposure.

• Improving your sleep hygiene: This includes keeping your bedroom cool, quiet, and dark, and avoiding food and electronics before bedtime.

• Quitting cigarettes: Smoking can contribute to collagen loss while causing blood vessels in the skin to shrink. Quitting may help reverse this to some degree.

• Lowering your salt intake: Cook food from scratch, eat fewer processed foods, rinse certain canned items (like beans), and choose low-sodium versions of foods you enjoy.

• Using a topical caffeine cream: Available over the counter, topical caffeine is thought to reduce eye puffiness by causing vasoconstriction (the narrowing of blood vessels). Be very careful in using creams around the eyes, and do not get it into the eye, as it can cause burning and damage.

Medications

Depending on the cause of your eye puffiness, different over-the-counter or prescription drugs may be useful, including.

• Oral antihistamines: Used to relieve allergy symptoms

• Antihistamine eyedrops: Used to relieve eye allergy symptoms

• Nasal decongestants: Used to relieve nasal congestion that contributes to puffy eyes

• Antibiotic eyedrops or ointments: Used to treat bacterial eye infections

• Steroid eye drops: Used to relieve eye inflammation

• Zovirax (acyclovir): An antiviral drug used to treat eye herpes

• Tepezza (teprotumumab): Used specifically to treat bulging eyes caused by thyroid disease

Cosmetic Procedures

Outside of cosmetics, several non-invasive treatments may ease chronic eye puffiness or baggy eyes:

• Dermal fillers: This involves the injection of a jelly-like material between the under eye and cheek to reduce the appearance of sagging.

• Chemical peels: Used to treat eye bags associated with aging, this procedure involves the application of a solution that dissolves the top layer of skin.

• Laser resurfacing: This involves using a laser to remove surface layers of skin to stimulate new collagen growth and improve skin quality and firmness.

• Periorbital doxycycline injection: An injection of this tetracycline antibiotic under the skin is thought to help reduce lower eyelid fat prolapse.

Surgery

Blepharoplasty is a cosmetic surgical procedure that lifts the lower eyelid. This is usually done on an outpatient basis under local or general anesthesia. It is a relatively common procedure used to readjust the fat in the lower eye area and tighten the muscles and skin surrounding the eye.

The results can vary based not only on the surgeon's expertise and experience but also on your age, skin quality, and personal expectations.