No health risk is associated with under-eye swelling, but it can still be troublesome.
Genes, bone structure, soft tissue changes with aging and lifestyle factors commonly cause under-eye swelling. It’s sometimes possible to reduce the appearance of swelling with simple remedies, although more complex treatments may be necessary.
Here are the causes, treatments and prevention tactics to keep under-eye swelling at bay [1]:
What is under-eye swelling?
Under-eye swelling, also known as ‘under-eye bags,’ is an accumulation or retention of fluid that causes the lymphatic system, which helps balance fluid in the body, to delay draining lymph fluid, says Djenane Bartholomew, DNP, who is based in New York.
It’s this under-eye bag, very often a result of excessive skin and tissue, that causes the swelling, says Jennifer DiLandro, RN, an adult nurse practitioner based in New York.
“It’s more common as you age because the tissues around your eyes weaken, including some of the muscles supporting your eyelids—and fat that helps support the eyes can then move into the lower eyelids, causing them to appear puffy.”
The eyelid skin is fragile underneath the eye and because of this, any fluid, vascular changes or fat prolapse is more visible with fluid retention. The under-eye bags appearing purple is often due to blood breakdown products and the visibility of the orbicularis muscle under the skin.
What causes it?
Various factors can cause under-eye swelling, including medical conditions, anatomy and diet-related swelling.
Medical conditions
Dermatitis, dermatomyositis, renal disease and Graves’ disease are all examples of conditions that affect body tissues and result in under-eye swelling, according to Bartholomew. For example, renal disease, which affects the kidneys, can lead to swelling around the eyes due to the kidneys leaking significant protein levels into the urine, resulting in eyelid edema (swelling) [2].
Around 33% of people with Graves’ disease, an autoimmune disorder that can lead to hyperthyroidism (an overactive thyroid), experience eye problems. In Graves’ ophthalmopathy, your immune system attacks the tissues and structures around your eyes, causing swelling and puffiness.
An external irritant can also cause your conjunctiva, the protective covering of your eyelid, to swell as a result of allergies [3].
Infections
“Infections such as periorbital cellulitis [a soft tissue and skin infection around the eye], blepharitis [inflamed eyelids] and conjunctivitis [eye infection caused by bacteria or a virus] are common reasons for under-eye swelling, as well as styes and chalazion (inflammation of the eyelid glands) ” says Anthony Rossi, MD, board-certified dermatologist and dermatologic surgeon with Memorial Sloan Kettering Cancer Center in New York and the founder of D. Rossi DERM MD skincare.
Fatty bags
Fatty bags, known as orbital fat pads, are cushions that surround and support the eyeball in the socket, explains Maya K. Thosani, MD, dermatologist, micrographic dermatologic surgeon and owner of Modern Dermatology in Scottsdale, AZ. “When these grow or protrude, it can cause swelling and bags around the lower eyes”.
Vascular circles
Dilated veins around the eyes, which cause vascular circles, may be the root of under-eye swelling. “When these veins dilate, it causes blue-tinged swelling and darker circles, which become more prominent as we age or lose volume in the face,” says Dr. Thosani.
Structural shadows
Under-eye swelling may also be a feature of your facial anatomy. “While prominent shadowing can cause swollen eyes, there are also some conditions like exophthalmos (where your eyes move forward and appear to pop out) that create a look of swelling,” says Dr. Thosani.
Under-eye hollows
Aging can cause volume loss in the upper portion of the face, says Dr Thosani. “The tear trough [under-eye] hollows, resulting in the lower eye area looking fuller and swollen.”
Diet
Factors like smoking, diets high in sodium, diets high in fat and excessive alcohol can cause eyelid edema, a swelling that results from vascular [the body’s blood vessel network] congestion, explains Dr. Thosani.
How to treat under-eye swelling?
In many cases, under-eye swelling can be resolved with minimal intervention. However, in chronic cases, more treatment may be required.
Dietary changes
As noted above, certain foods, such as sodium-rich meals, can affect how the lymphatic system drains fluid from your body. In other words, diets high in salt can lead to water retention and an excess buildup of fluids in the body, your face included.
Face massage
Massaging the face can help drain fluid buildup around the eyes. Dr. Thosani suggests using a massaging action while applying moisturizer daily or a cooling facial roller with a firm cold touch, to help shrink swollen blood vessels or lymphatics.
Fillers
Derma fillers containing hyaluronic acid. – a hydrating substance found naturally in the body – are an increasingly popular cosmetic procedure.
“Fillers minimize the appearance of vessels and are the most helpful for structural shadows and other factors that cause swelling under the eye as they restore the volume and prevent the shadowing effect that makes under eyes look swollen, puffy and tired,” explains Dr Thosani.
A 2021 study in the Aesthetic Surgery Journal found VYC-15L, a form of hyaluronic acid, to be a safe and effective treatment for moderate or severe infraorbital hollowing (which includes tear trough hollowing) that lasted for one year [4].
Medications and ointments
Allergies that cause your eyes to swell can often be counteracted with allergy medications and a healing ointment that reduces itchiness and irritation, such as Aquaphor and CeraVe, according to Dr Thosani, who adds that itchy eyes that cause excessive rubbing can be relieved with medication from a dermatologist.
How to prevent under-eye swelling?
There are a few easy-to-implement methods to reduce under-eye swelling. DiLandro suggests simple day-to-day switches such as cutting down on all fluid intake before bedtime, not smoking and ensuring adequate sleep.
She suggests that if you live with allergies, limit your exposure and try home remedies like placing cucumber slices over your eyes to reduce swelling. Antihistamines also possess anti-inflammatory properties if an allergy is to blame for eye swelling [5].
Bartholomew suggests avoiding or cutting salt and processed foods from your diet. “Extra sodium can cause water retention that gathers and presents under the eyes, face and body.” Instead, she suggests eating potassium-rich foods—yogurt, bananas, potatoes and dried apricots included.
“Potassium increases urine production and decreases sodium effects, while an increased intake of water can help flush out additional sodium.”
“Cold ice compresses will help with vasoconstriction [narrowing] of the blood vessels around the eye and reduce redness and puffiness,” adds Dr Rossi.
When to see a doctor?
Although most under-eye swelling should resolve on its own, you should seek medical attention if it persists for more than 24-48 hours and is accompanied by symptoms of an eye infection, such as redness, white fluid or pus and swelling in one eye or pressure, says Bartholomew.
“You should also visit a doctor if under-eye swelling causes vision problems, irritation, headaches or is accompanied by a skin rash,” says DiLandro, as your health care provider will want to rule out other possible causes that can contribute to the swelling, such as thyroid disease, infection, connective tissue disease or an allergy.
[1] https://www.forbes.com/health/body/under-eye-swelling/
[2] https://www.kidney.org/news/ekidney/august14/10_Signs_You_May_Have_Kidney_Disease
[3] https://allergyasthmanetwork.org/allergies/eye-allergies-conjunctivitis/
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8520027/
[5] https://pubmed.ncbi.nlm.nih.gov/12113215/
