What causes puffy under eyes?

What causes temporary puffiness?

• Fluid buildup: Fluid collects in the thin tissues around the eyes. Salt encourages water retention, and fluid can build up while you sleep.
• Poor sleep: Not getting enough sleep can leave you waking with bags under your eyes.
• Allergies or irritating products: Mascara, eyeshadow and eye creams can irritate the surrounding skin or trigger an allergic reaction.
• Local swelling: A nearby insect bite, injury or operation can cause eyelid swelling.

Why do some eye bags stay?

Normal fat behind your eyes cushions nerves, blood vessels and muscles, which is a respectable job for something with such poor publicity. With time and gravity, that fat can move forward and appear as bags beneath the lower lids, which makes gravity an awkward partner for a lifting campaign. Skin also loses elasticity, and excess skin contributes to bags. The thin skin around the eyes stretches over time with blinking, sun exposure and aging. The name 'eye bags' covers both swelling and structural changes.2

Dark circles are not necessarily swelling. Hollows beneath a bag can cast shadows, and extra pigment can also darken the area. A hollow, a shadow and a bag can sit together, despite being assigned the same department at the cosmetics counter. Sunken eyes are different again: the eye itself sits farther back in its socket, sometimes because of aging changes or an injury.24

What if the area is itchy, crusty or painful?

These symptoms point beyond ordinary cosmetic bags. Blepharitis, inflammation of the eyelids, can cause redness, itching, burning and crusty eyelashes. A stye is a small, painful red bump caused by an infected oil gland; a chalazion is a painless lump that can follow a stye. Allergies and conjunctivitis, inflammation of the eye's surface lining, can also cause swollen eyelids. These clues help guide an examination, but do not diagnose the cause yourself.35

What can you do for mild puffiness?

• Use a cold, wet washcloth over closed eyes for a few minutes.
• Aim for seven to nine hours of sleep and raise your head slightly with another pillow.
• Limit salty foods if water retention is contributing.
• Stop suspected irritating eye products for at least a couple of weeks to see whether symptoms improve.
• Remove contact lenses immediately if your eyes or eyelids swell. Antihistamine eye drops help only when allergies are the cause; use steroid eye drops only as prescribed.

Temporary swelling often settles within a day. Seek an eye care professional if swelling lasts longer than 24 to 48 hours. Lasting structural bags need a different approach: an eyelid specialist can assess whether removing or repositioning fat and addressing excess skin would help. Removing fat alone can deepen the hollow beneath a bag.12

When should you get medical help?

Get urgent care for a red, hot, painful or tender swollen eyelid, trouble opening the eye, light sensitivity or changes in vision. A bacterial infection around the eyelid can become dangerous if it spreads behind the eye. Persistent watering also deserves assessment; avoid rubbing watery eyes.356

If the eyeball itself sticks out more than usual, get it checked promptly. An overactive thyroid is a common cause of bulging eyes. Seek emergency care for sudden severe eye pain, or new bulging with vision changes, severe headache or nausea.7