Eye Swelling in Children – Common Causes and When to Get Help

Swelling of one or both eyes is common in children.  The causes vary from simple irritation, insect bites, or pink eye, to potentially serious bacterial infections.  

It is important to know when eye swelling is more serious and when it needs medical evaluation. 

For this discussion eye swelling is defined as swelling of the eyelid(s) and surrounding areas of the eyes. This is commonly referred to as the peri-orbital area.  

• Mild swelling – the eyelids are puffy but most of the eye(s) can still be seen. 
  • Allergic conjunctivitis – usually occurs in both eyes and is itchy 
  • Viral conjunctivitis – usually in both eyes, eyes are red, cold symptoms may also be present. 
  • Bacterial conjunctivitis – Purulent (pus) discharge is present.  It may start in 1 eye but often spreads to both sides. 
  • Insect bite – usually on 1 side and is often itchy and can sometimes increase to moderate or severe swelling.  
  • Trauma – bumps or bruises as well as irritation from frequent rubbing   
  • Stye – mild swelling (with or without redness) of a single eyelid caused by bacteria build-up in a blocked gland in the eyelid.  Resolves with time and frequent warm compresses.  

• Moderate to Severe Swelling – eye is swollen mostly or entirely shut. 
  • Periorbital Cellulitis – This is a skin infection surrounding the eye area including the eye lids. 

• • • It may start with a bug bite or minor injury and progress to a more serious infection.  Symptoms included painful, red, swollen eyelid and surrounding area.   
    • The swollen red area is usually tender or painful, however the eye itself is not painful as the infection involves the skin around the eye only.  
    • Fever may occur. 
    • Treatment usually requires oral antibiotics.  

• • Orbital Cellulitis – This is a bacterial infection of the interior structures surrounding the eye and should be considered an emergency.  

• • • Swelling around the eye, usually one side only, which is sometimes red and tender but not always.   
    • Fever is often present. 
    • Pain is in the eye itself, especially with movement of the eye. 
    • The eye may also seem to be bulging compared to the other side. 
    • Symptoms of sinusitis including sinus pressure and pain on the same side are often present, including prior to the swelling starting.  

• • Allergic Reaction/Anaphylaxis – this may occur after ingestion of a food, medication, or exposure to other allergens. 

• • • Other symptoms of anaphylaxis include cough, wheezing, difficulty breathing, swelling of mouth or throat, vomiting, hive or rash, fainting or losing consciousness.  
    • If symptoms of anaphylaxis occur call 911 immediately and administer an intramuscular epinephrine injection (EPIPEN) if the child has one from a known allergy.  
    • See our detailed blog on Anaphylaxis for more information.   

Call your pediatrician for evaluation of any moderate to severe eye swelling on 1 side (when an insect bite is not the cause) or any swelling when redness or tenderness is present.  

Seek immediate evaluation for any severe swelling of both eyes or if eye swelling is present with fever, eye pain, change in vision (such as vision loss or double vision), your child looks or acts very sick, or for any signs of allergic reaction/anaphylaxis as discussed above.  

Resources –  

Healthychildren.org Eye Swelling.