Bye-Bye Puffy Eyes: Here’s Our Complete Guide to Eye Puffiness

Puffy eyes can be a temporary issue or a recurring problem., depending on what causes them. Persistent eye puffiness might not only be a cosmetic issue but could also indicate a deeper health problem. Unlike puffy eyes, ‘undereye bags’ are common as we grow older and are linked to genetic predispositions, poor cardiac health, and more. 

Puffy eyes or periorbital oedema is when the skin around the eyes appears inflamed, swollen, and soggy. The underlying cause involves the accumulation of fluids around the eye socket — the orbit — that makes the skin appear inflated and puffed.

Eye puffiness is a multifactorial issue. It is temporary and usually disappears within 24-48 hours after the cessation of the cause.

Sleep insufficiency: The normal breathing patterns of a sleep cycle between REM and non-REM sleep get altered when you stay up late or have been sleep-deprived for days. This triggers sleep-disordered breathing that delivers poor oxygen supply to the body. In order to make up for the deficit, blood vessels widen to provide additional oxygen to the tissues. These dilated blood vessels can cause fluid to leach out into the skin, especially in areas where the skin is thin and delicate — around the eyes. 

Excessive crying: The salt in the tears can cause fluid retention around the upper and lower eyelids, making them puffy.

Allergies: Seasonal allergies, food allergies, and those from medicines can cause eye puffiness. Exposure to an allergen releases an allergy-mediating chemical called histamine into the bloodstream. Histamine triggers inflammation, leading to the swelling of blood vessels and fluid leakage into nearby tissues. Thus, apart from puffed eyes, even the inside of the nose, throat, and mouth can get swollen. These allergens could be anything from seafood, lactose, dust, mites, pollen, etc. 

An allergy-related puffy eye episode is usually bilaterally on the eyes unless it is due to a bug bite or contact allergy.

Flu: In seasonal flu, cold, and fever, the eyes and nose are affected, and puffiness and sneezing can happen. Nasal congestion worsens it by draining fluid into nearby tissues, including around the eyes.

Diet: Eating high sodium-containing foods causes more water to flow out of the cells into the intertissue spaces. Such water retention happens in different areas of the body, including the eyes. Overconsumption of processed or packaged foods, fast food, alcohol-based drinks, etc. are the biggest risk factors for eye puffiness.

Acute eye diseases: Several conditions also present with puffy eyes as a symptom. The most common ones are:

• Conjunctivitis: Inflammation of the eye conjunctiva, also called pink eye
• Stye: A minor infection of the eyelid
• Blepharitis: Eyelid inflammation
• Chalazion: Blocked gland at the base of the eyelid

Others include thyroid disorders, diabetes, optic nerve issues, and more. 

Puffy eyes are usually visible and easy to detect; however, they must be differentiated from ‘undereye bags’ that need prompt medical attention.

• Swelling under the eyes
• Swelling in the upper  eyelid
• Redness of the eyes
• Excessive tearing 
• Dark circles
• Eye itchiness and soreness
• Sensitivity to light 
• Discharge from eyes

The diagnosis of eye puffiness is based on a thorough history of the development of eye puffiness and related symptoms. 

Some common ways on how to reduce eye puffiness:

• Improve your sleep: Adults 18 years of age and up should aim for 7 to 8 hours, while teenagers 13 to 18 years must get 8 to 10 hours of sleep per day. It is best practice to complete dinner 2-3 hours before bedtime and avoid late-night screen time to induce restful sleep. In case you are prone to puffy eyes, prop up the pillow or use doctors’ prescribed, ergonomically compatible pillows to raise the head above the body and reduce fluid accumulation.
• Drink enough water: At least 8 glasses of water is a must to prevent dehydration, which induces water to leach out of the cells and accumulate.

• Address allergies: Over-the-counter medications for allergies or ways to prevent allergen exposure can reduce allergy incidents. 
• Address the flu early: Steam inhalation, warm saline gargles, and nasal decongestants can work wonders to reduce the inflammation and the fluids that cause puffy eyes. 
• Diet: Cut back on high-sodium foods like packaged processed foods, junk fried foods, and alcoholic beverages. Potassium-rich diets like bananas, green leafy veggies, etc., can reduce excess fluids in the body. However, it is best to work closely with your dietician and doctor to decide what’s best for your body.

Dr Snehankita Chawdhry, MBBS, Doctor of Medicine, MD, DVL, Dermatology, says, “The four points to remember in under eye care are:

• Periorbital skin is thin compared to the rest of the face, making it easily prone to irritation. Certain products safe for use over the face may not be safe for use around the eyes.
• 8-10 hours of sleep, good nutrition, water intake, and sun protection are all essential.
• Limit screen time wherever possible.
• Consult a specialist to distinguish between the various causes of puffy eyes since treatment depends on the underlying cause.”

Eye puffiness is an issue. While in some cases, puffed-up eyes are just a ‘one-time’ thing and can be completely reversed at home with lifestyle modifications, other instances may need a visit to an eye specialist or skin consultant. It is always best to work closely with a doctor and a dietician to better follow a strict eye care regimen.

Puffy eyes may last for a few minutes to an hour after crying, depending on the intensity and duration of crying and one’s propensity to develop swollen eyes.

Puffy eyes after crying can be easily reversed with cool compresses, chilled cucumber, eye washes, and gentle massages. 

Eye puffiness may be serious if it persists for over 24 hours and has related symptoms of eye discharge, severe redness, pain, itchiness, and blurred vision.

Eye puffiness can be worrisome if it lasts longer than a few hours to a day and is related to signs of blurred vision, pain, itching, eye discharge, and extreme redness.

Severe liver disease has been related to fluid retention and, in turn, puffy eyes; however, it also has other signs and symptoms.