Swollen eyes

and Eva Rudolf-Müller, doctor

Hanna Rutkowski is a freelance writer for the medical team.

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Eva Rudolf-Müller is a freelance writer in the medical team. She studied human medicine and newspaper sciences and has repeatedly worked in both areas - as a doctor in the clinic, as a reviewer, and as a medical journalist for various specialist journals. She is currently working in online journalism, where a wide range of medicine is offered to everyone.

More about the experts All content is checked by medical journalists.

Puffy eyes - often in combination with dark circles - can quickly make the face look tired and puffy. If the cause is too short a night or an unhealthy lifestyle, the big eyes disappear again during the day. However, swollen eyes can also occur in the context of various and sometimes serious diseases. Read more about causes of puffy eyes and what to do about them.

Brief overview

Causes: e.g. short night with a lot of alcohol consumption, a lot of computer work, dry air, cold, allergies, eye diseases (stye, hailstones, conjunctivitis, tumors in the eye area etc.), heart failure, kidney failure
What to do with puffy eyes In the case of harmless causes, cool the area around the eyes, drink a lot, use special care products if necessary, possibly a gentle eye massage
When to the doctor if no cause can be identified and / or the eyes are additionally painful, watery, reddened or the eyesight deteriorates
Diagnosis: Doctor-patient discussion to collect the medical history, ophthalmological examination, smear, possibly tissue sample, further examinations depending on the suspected cause
Treatment: depending on the underlying disease, e.g. B. with antibiotics for bacterial eye infections

Puffy eyes: causes and possible diseases

Allergies, colds or violent, prolonged crying often cause the eye area to swell temporarily. The fluid deposits that make the tissue in the eye area (and possibly also in other parts of the body) thick can also be caused by other diseases. The main causes of puffy eyes are:

Eye diseases

Stye (hordeolum): The stye is a contagious, purulent inflammation of the glands on the upper or lower eyelid, triggered by certain bacteria (staphylococci). An encapsulated collection of pus (abscess) forms on the inside or outside of the eyelid. The area is swollen, red, tender, and quite painful.
Hailstone (Chalazion): In contrast to the stye, the hailstone only occurs on the upper eyelid when the ducts of the meibomian glands located here become blocked. The eyelid swelling is painless in this case.
Tumor around the eyes: What sometimes looks like a hailstone is actually a malignant tumor of the eyelid glands. This can also cause puffy eyes.
Conjunctivitis (conjunctivitis): It can be viral, bacterial, allergic or mechanical (caused by foreign bodies). Signs are a swollen eyelid, swollen conjunctiva, a reddened, watery and (in the morning) sticky eye, photophobia and sensitivity to glare as well as a pressure or foreign body sensation in the eye. Depending on the cause, the inflammation affects only one eye or both eyes. The bacterial form in particular is contagious and can quickly spread through the family via contaminated towels.

Orbital phlegmon: This is a bacterial inflammation of the entire eye socket, which is often the result of a stye or sinus infection. It must be treated as quickly as possible, otherwise there is a risk of blindness. A severely swollen eyelid, pain, fever, reddened conjunctiva and a protruding eye can be the first signs of orbital phlegmon (or orbital phlegmon).

Other diseases

Allergy: Allergic eye irritation such as hay fever usually affects both eyes at the same time. Watery, reddened and severely swollen eyes, accompanied by itching or burning, as well as runny nose and sneezing are typical signs. An allergy to house dust mites can also only show through swollen, red eyes in the morning after waking up.
Quincke's edema (angioedema): This is an acute, painless swelling of the skin and / or mucous membrane. It can occur anywhere on the body, including the face: the eyes, chin, cheeks and lips, including the mucous membranes, are particularly affected. The swelling can be associated with an uncomfortable feeling of tightness. Quincke's edema is very often allergic.
Kidney failure: When the kidneys stop working properly, water retention (edema) occurs throughout the body. In addition to the legs, the face can also swell here. Affected people pass less urine, and unspecific symptoms such as concentration disorders and rapid fatigue occur.
Heart failure: Chronic heart failure (heart failure) leads to edema (water retention) in the legs, abdomen and face due to the reduced pumping capacity of the heart.
Cold: Sometimes big eyes are the result of a simple cold.
Inflammation of the paranasal sinuses (sinusitis): Sinusitis can also swell the cheeks and / or cause the eyes to swell.
Thyroid Disorders: Severe underactive thyroid (hypothyroidism) can cause pasty swelling of the face and extremities with dry skin. In contrast, the autoimmune disease Graves' disease leads to an overactive thyroid gland (hyperthyroidism). A typical symptom is protruding eyeballs. In addition, many sufferers develop puffy eyes and conjunctivitis.
Cluster headaches: People with cluster headaches are often woken up at night by the intense pain around one eye. The pain attacks last up to three hours. The eye tears and swells. Conjunctivitis or a drooping eyelid is also possible.

Other causes of puffy eyes

Dry eyes: Contact lenses and work on the computer dry out the eyes and cause reactively swollen eyes, especially in the evening. In winter, the warm, dry heating air can also cause discomfort to the eyes.
Crying: When crying, the pressure in the area of the eye, which acts on the surrounding tissue, increases. This squeezes fluid out of the fine blood vessels, especially in the delicate area of the lower eyelid, resulting in swollen eyes.
Heredity and age: Large bags under the eyes are often due to a family predisposition. In addition, the tissue slackens with age, which also favors puffy eyes and bags under the eyes.
Disturbed lymphatic drainage during sleep: The flat position when lying down makes it difficult for the lymphatic drainage, which can cause the eyes to be swollen in the morning.
Diet and alcohol: Anyone who consumes a meal that is high in protein or salt or drinks plenty of alcohol in the evening often wakes up the next day with puffy eyes (due to congested lymphatic fluid).
Female cycle: Many women have puffy eyes due to hormonal factors at the time of ovulation or during menstruation.
Slap in the eye: The well-known "violet" occurs as a result of a blow or bump in the eye area when the injured vessels bleed into the tissue around the eyeball. Swelling is typical here; later it changes color like a bruise.

Anyone who has received a blow or substance against the eye should always see an ophthalmologist. Bones in the eye area could be broken and / or the eyeball injured!

Puffy eyes: you can do this yourself

To eliminate or prevent puffy, small eyes, which are almost certainly not based on a (serious) underlying disease, you don't need to see a doctor straight away. You can try the following home remedies and tricks first:

Drink enough: A truism - but one that is true. Sufficient fluid intake (preferably in the form of water) helps to get the lymphatic system going and to avoid swelling around the eyes.
Cooling: Put a spoon or cooling goggle in the refrigerator overnight and gently place it on the swollen eye for about ten minutes. This is good for you and supports the swelling.
Eye care products: The cosmetics industry offers a wide range of roll-on sticks with decongestant or diuretic ingredients. For example, caffeine or green tea should reduce swelling of the eyelids. Often the most important effect of the products is their cooling effect.

Cucumber on the eyes: Freshly cut cucumber slices on the eyes are tried and tested. They not only have a cooling effect, but also donate moisture to the skin.
Massage: In combination with care products for the sensitive eye area, you can massage your eyelids gently - either with circular movements around the eyes or by gently tapping the bridge of the nose along the lower eyelid.
Lymph drainage: It can reduce the swelling. To do this, close your eyes, gently stroke your fingertips five times from the bridge of your nose over your upper and lower eyelids towards your temples. This is supposed to stimulate the lymph flow and help remove waste products. Even better: leave the lymphatic drainage to an expert (e.g. physiotherapist).
Sleep with your head slightly elevated: Lymphatic drainage is difficult when you are lying down, which can lead to puffy eyes in the morning. On the other hand, it helps to sleep with your head slightly elevated - or just be patient: unlike real "bags under the eyes", which are caused by fat deposits in the lower eyelid and the underlying tissue and are caused by age or genetics, these edemas are emptied within hours with the help of the Gravity by itself. So they only present a temporary aesthetic problem.
Replacing contact lenses: If a bacterial infection is causing puffy eyes, you should change your contact lenses. The old lenses could be contaminated with germs and cause a new infection. When handling the lenses, make sure that your hands are clean.

Hemorrhoidal ointment: Applying a thin layer of hemorrhoidal ointment to the eyelids can reduce puffiness in the eyes. The ointment ensures that the blood vessels contract. But do not use products that contain cortisone and local anesthetics! Preparations with extracts of horse chestnut are more suitable: this medicinal plant has a natural decongestant effect. When applying, make sure that no ointment gets into your eyes!

Many experts are critical of the use of hemorrhoid ointment for puffy eyes and advise against it.

Puffy eyes: when to see a doctor?

Puffy eyes as a result of too little sleep, a night of partying or extensive crying are harmless. A doctor's visit is not necessary here. Instead, you can use home remedies yourself to help the swelling go down more quickly (see above: "You can do this yourself").

However, if you frequently have swollen eyelids for no apparent cause, you should see your doctor. He may find a previously undiscovered allergy or other illness as the cause of the eye swelling. If necessary, he will refer you to a specialist, for example an ophthalmologist (if you suspect an eye disease), an endocrinologist (if you suspect a thyroid disease) or a cardiologist (if you suspect a heart disease).

Also see a doctor (ophthalmologist) immediately if the eyes are not only puffy, but also pain, watery, reddened and / or tender. It may be due to a bacterial infection that should be treated urgently - not only because of the risk of infection for others, but also because of the risk of (permanent) damage to the eye.

It is imperative that you go to the ophthalmologist quickly even if, in addition to the swelling in the eye area, you also notice decreasing eyesight!

Puffy eyes: examinations

First of all, the doctor will ask you about your medical history (anamnesis): Among other things, he will have the symptoms described in detail, how long they have existed and whether you are aware of any underlying diseases (e.g. allergies, thyroid, heart - or kidney disease).

The ophthalmologist can then carry out an ophthalmological examination. This is how you can determine whether an eye disease is responsible for the puffy eyes. High blood pressure or diabetes can also trigger pathological changes in the eye area.

A swab of the eye secretion can be examined for pathogens.

In the case of tumorous, solid swellings, the doctor can take a tissue sample for more detailed clarification. If necessary, the doctor often surgically removes the entire tumor and then has it analyzed in the laboratory. Diagnosis and therapy go hand in hand here. In addition, if necessary, he can take further therapeutic steps after the procedure.

Depending on the suspected cause of the eye swelling, further examinations may be useful, for example heart ultrasound and EKG if a heart disease is suspected.

Puffy eyes: treatment

If swollen eyes have a cause that requires treatment, the doctor will initiate appropriate therapeutic measures. Some examples:

If puffy eyes are the result of bacterial inflammation (as with stye), the doctor often prescribes local antibiotic preparations. In addition, patients should ensure absolute hygiene and cleanliness here - the pathogens can quickly spread to other people through dirty hands or shared towels.

A stye is more harmless. It rarely needs to be opened by the ophthalmologist to allow the pus to drain. But never try to express a stye yourself! Otherwise it can happen that you accidentally introduce the germs into the healthy eye, which then also becomes infected.

If there are general illnesses such as cardiac or kidney failure, these must be treated specifically. Then the puffy eyes and other symptoms of the disease usually go away.

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