What is periorbital oedema?

There are signs of fatigue that one cannot ignore, like feeling tired, even exhausted after a "good" night sleep, or puffy, red eyes.
Usually, one coffee or two, and a splash of cold water does the trick to make you feel like your 'normal' self again. But in some people, dark circles and puffy eyes become a permanent feature on their face.

While puffy eyes — water retention under the eyes, or in the eyelid — should resolve quickly, there could be many causes to permanently puffy eyes.

Periorbital oedema is the term used to describe swelling around the eyes, either in just one eye or both at the same time.

One of the main causes is obvious: disturbed or irrugular sleep patterns. Too little or too much sleep can cause fluid retention around the eyes (but also anywhere in the body, like the legs, ankles or fingers).

The second obvious reason is: dehydration. and any habits that leads to dehydration, including excessive caffeine intake (and other diuretics, natural, over the counter or prescribed) and alcohol consumption. Because the body requires water to function, it will try to preserve as much as it can but fluids also have more difficulties circulating around the body, leading to pools building in some tissues.

The third reason that may jump to mind is: excessive sodium intake (table salt, ultra-processed foodstuff, including salty snacks and nibbles, gravy granules and the likes).

Periorbital oedema is not to be confused with periorbital cellulitis, which is an infection (-itis = infection) of the eyelid or the skin around the eyes, which can be seen in adults but most particularly young children under the age of two. Periorbital cellulitis is the result of a bacterial infection due to bacteria penetrating the skin through a scut or cratch, or sinus infection (sinus-itis). It can also happen because of a stye (infection of a gland in the eyelid). In these cases, signs also include redness in areas around the eyes and the white of the eyes, soreness or tenderness, but there should not be fever or pain. These should be signs of something more serious like orbital cellulitis, which affects the eye itself.
Becasue it is an infection, periorbital cellulitis is treated with anitbiotics.

Periorbital oedema, however, doesn't require antibiotics.

Different diagnosis that do not require antibiotics treatment are viral infections. For example, "mono", or infectious mononucleosis, which refers to a group of symptoms often caused by the Epstein-Barr virus (EBV, a member of the herpes virus family), an infection predominently contracted during the teen years. Because the virus is spread through saliva, it's usually refered to as “the kissing disease.” But EBV infection can be caught at any age and resembles common flu, which makes it difficult to spot. Symptoms include high fever, swollen lymph glands in the neck and armpits, sore throat, headache, fatigue and muscle weakness, and the infection usually clears within one month or two.


Acute inflammation can cause fluid buildup around the eye but also can build up overtime. There are three reasons that we have discussed already, poor sleep patterns (too much or too little sleep), dehydration (not drinking enough water or using diuretics, or excessive caffeine and alcohol intake). Other causes include:

• allergies — inflamed capillaries (tiny blood vessels) around the eyes.

• tobacco smoking (and potentially vaping) — smoking can lead to hormonal imbalances causing oedema (fluid retention).

• crying for long of periods of time (grief, depression, intense sadness) irritates the eyes, which can lead to swelling and transient periorbital oedema.

• trauma or injury.

• ageing (older people tend to drink less and move less, causing water retention in areas like the tissues around the eyes.

Swelling around the eyes can hide more concerning health conditions, which are often accompanied by many more symptoms. Such condition include:

• under-active thyroid gland, also known as hypothyroidism. This condition can also be the result of an autoimmune disorder (e.g. Hashimoto's disease), whereas your immune system attacks your thyroid. The thyroid becomes damaged and can't make enough thyroid hormones, slowing down everything in your body, including metabolism and fluid movement.

• kidney disease or nephrotic syndrome (in the latter, the kidney filtering system is damaged, and large amount of proteins is lost in the urine. Protein have a great osmotic power (attracts water) and are key to maintaining fluid balance in the blood, lymph and interstitial fluid (the liquid bathing every cell in the body)

To determine the underlying cause there are some tests your doctor may ask you to do, including blood tests (to search for infection or determine thyroid function), allergy tests, biopsy, or scans.

Your doctor may also recommend you to drink more and to follow a low-salt diet. He may also prescribe corticosteroids and other anti-inflammatory (drugs to reduce inflammation and associated pain (if applicable), either topically or orally, antihistamines (if allergies are suspected), or antibiotics (if bacterial infection is confirmed)
You may also apply cold compress (or cucumber slices) on your eyes to help with the swelling.

The most efficient form treatment is the treatment that is addressing the direct cause(s).

If sleep is the cause, then re-establishing sleep patterns would be the most important form of treatment, often in addition to other techniques like relaxation, meditation, mindfullness, hypnotherapy, acupuncture, CBT, or any exercises that can help you sleep and stay asleep. Sleep on your back to allow for fluid to circulate. Lying on your stomach and your face can lead to poor distribution and fluid accumulation in the face as you sleep.

If diet is the problem (excessive salt intake, high caffeine and alcohol consumption), then address it the best you can. Learn to cook without too much salt, and never put salt on the table. Many people have fallen into the habit to salt their food without even tasting it, and so became addicted to the salty taste. Drink one or two coffee a day but not more (if caffeine is the leading cause of dehydration), and always — ALWAYS — keep a bottle of water with you so you remember to drink. If necessary set an alarm to remind you to drink. Many apps do this for you. So there is no excuse to not drink regularly and keep hydrated. Add a slice of lemon or cucumber to keep your water 'interesting' if drinking plain water is problem for you.
Also avoid food laden with salt and sugar like all ultra-processed foods (e.g. biscuits, snack and ready-made meals).

The best way to deal with allergies is to reduce, avoid, or eliminate possible allergens. Be aware of the products you apply daily on your skin. You may react to chemicals in your make-up and/or personal care products and keep the area under the eyes chronically inflamed. Use dermatologically-tested products, scent-free, and designed for babies or sensitive skin types. The same for laundry detergents and softeners. Residues trapped in the fabric of your sheets and pillow cases can bring symptoms as you sleep.
Chronic sinus congestion (also a sign of allergies) can interfere with fluid drainage and cause the tissue around your eyes to swell. Use natural saline solution to clear your sinuses naturally.

You may also want to check your home for moulds, as mycotoxins (byproducts released by mould that are extremely volatile and can enter the airways and colonise any part of your home where it is warm and humid).

If you have eliminated every eventual causes but still have 'bags' under your eyes, then age is likely to be the factor contributing to your under-eye puffiness (especially, if you're no longer in your twenties). Loss of tonus and weakening tissues and muscles allow for fat to move under your eyes and/or fluid accumulation. Ask you doctor about solutions if it is really affecting your day-to-day life and confidence.