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Q: swelling under the eyes. ( Answered,   0 Comments )
Subject: swelling under the eyes.
Category: Health
Asked by: jtanner-ga
List Price: $100.00
Posted: 14 May 2003 15:39 PDT
Expires: 13 Jun 2003 15:39 PDT
Question ID: 203795
Around 6 years ago the areas beneath both eyes began to swell - I
think this was caused in some way by sleep as I noticed some days it
was less pronouced than others. This accumulated for some time and I
was advised that laser skin resufacing would help as it would tighten
the skin under the eyes. This was done about 3 years ago and only made
the situation much worse, and now the area under the eyes appears
filled with fluid.
I have seen a cosmetic surgeon who has told me they think it is a
drainage problem. They also advised that lymphatic drainage might be a
solution but I have yet to fully explore this. I do know that around 7
years ago I had an infection which appeared to cause a lump on my neck
just under the jaw line (I have had this lump checked and it is not
cancerous) - not sure if this would impede the drainage of the lymph

I think sleep may in some way be the problem as I have noticed that
the problem did once appear a little better (permanently) one morning.
It is not the quality of sleep or elevation of my head as the time the
problem improved the sleep wasnt great and my head wasnt elevated.

Ice doesnt work, nor does sleeping with my head elevated. I dont think
the problem is dietary as I have a balanced diet, drink plenty of
water (but not too much just before sleep). I get 8 hours sleep per

I'd really appreciate thoughts on the cause and treatment of this.

Subject: Re: swelling under the eyes.
Answered By: umiat-ga on 15 May 2003 11:58 PDT
Hi, jtanner-ga!

 We are usually the ones who notice our "flaws" more than others do.
However, I understand your desire to find a reason and possible
solution for your swollen lower eyelids. Since you did not mention any
*pain* associated with this condition, I am assuming that your concern
is primarily cosmetic. I also understand that you believe the
infection you had seven years ago "might" possibly be contributing to
the swelling under your eyes, but you are not sure.

 Since I am not a medical doctor, I cannot give you a diagnosis.
However, I can provide you with some "thoughts on the cause and
treatment of this," based on research.

 My initial "thoughts" revolve around four possibilities..... fat
deposits due to genetics and aging that can be surgically removed, a
mild but chronic sinus infection, mild allergies and a lymphatic
drainage problem.

 Please keep in mind that there are variations in the severity of
symptoms in all of these conditions. For example, one of the symptoms
of eyelid edema caused by allergies is a "crinkly appearance," which
you have not mentioned. The lack of one of the symptoms does not rule
out allergies altogether, however. With that in mind, let's start with
these four possibilities first!


Excessive fat deposits in the lower eyelid:

 You mentioned that you have visited a cosmetic surgeon, first for
laser surgery and secondly for a consultation concerning the swollen
lower lids. You mentioned that the laser surgery was supposed to
"tighten" the skin under your eyes, but that the laser surgery merely
worsened the appearance. Now, the area appears filled with fluid. Am I
correct in assuming that the skin was originally quite loose, or
baggy, since the original reason for the laser surgery was to tighten
the skin?  In other words, if the swelling were to go down, would the
lower eyelid skin then be quite loose?

 The condition you are describing sounds like a very common, and
somewhat disagreeable reality of older age for many of us! It involves
a weakening of the eyelid tissues, loosening of the skin, and bulging
of the normal, cushioning fat deposit that makes our eyelids so
smooth, plump and attractive when we are young (and don't appreciate

 The fact that the cosmetic surgeon did not suggest Blepharoplasty,
however, which involves the removal of excess fat under the skin of
the eyelids, suggests that the doctor must have ruled this out as
being the cause. Was Blepharoplasty mentioned, or was it discounted?
Might it be worth getting a second opinion from another cosmetic

 In case you are not familiar with the relationship between excess fat
and bulging or baggy lower eyelids, you might want to read the
following excerpts:


"Blepharoplasty: The Definitive Solution to a Youthful, Rested
Appearance." Global Plastic Surgery.

"Eyelid deformities may be the result of aging, or may occur from a
heredity predisposition in the family. Excessive bulging or bagginess
occurring before age 30 is usually a result of hereditary family
characteristics. With aging, the tissues which support the eyelid
become looser, allowing fat within the eye socket to bulge forward and
produce bags. The aging process causes further loosening in the skin
above the upper and lower eyelids, contributing to a wrinkled and
bagging appearance."

"In the lower eyelids, bagging results from fat bulging forward as
well as from excessive skin looseness. Bagging of the lower eyelids is
extremely apparent, cannot be camouflaged by any make-up technique,
and produces a stressed or tired appearance."

"Correction of both upper and lower eyelid deformities involves
precise removal of appropriate amounts of excess skin and fat. This
surgical procedure is called BLEPHAROPLASTY."


From "Blepharoplasty." Laser and Cosmetic Surgery. Highgate Private

(There is a little graphic of the procedure....somewhat
grotesque.....they could have made it look a bit more pleasant!)

Sagging Lower Eyelids

"Puffy, baggy eyelids are a telltale sign of ageing - and a
distressing one because the problem is nearly impossible to hide.
Furthermore, almost everyone develops some degree of bagginess under
the eyes, with time."

"The eye is surrounded with fatty tissue encased in a membrane that
tightly holds it next to the eye. This membrane weakens as it ages,
and the fat begins to protrude. This stretches the skin and muscles of
the lower eyelid and causes noticeable bulges. It is not always a sign
of age; heredity is a big factor and bags often occur in young people
too, and since they only get worse with age, it can be a good idea to
have the problem dealt with early."


From "Eyelid Surgery. Questions and Answers."

Why do I have bags under my eyes? 

"There are a couple causes. The first is changes in your "orbital
septum," which is a membrane that keeps in place a series of fat pads
that protect your eye within the eye socket by using flotation. When
the orbital septum weakens due to age or heredity, the fat starts to
protrude, which forms bags or pouches beneath the lower lids. The
second cause is the thickening of the eye muscles, which can sometimes
create the appearance of bags. Sometimes bags are a symptoms of
various medical conditions, such as thyroid and kidney disease. If
this is the case these disorders should be considered before eyelid
surgery is performed."

What if my medical condition is being treated, but the bags under my
eyes won't go away?

"Then eyelid surgery may be the answer."


Also read "Excerpt from Dermatochalasis." eMedicine.

"Redundant and lax eyelid skin and muscle is known as dermatochalasis.
It is a common finding seen in elderly persons and occasionally in
young adults. Gravity, loss of elastic tissue in the skin, and
weakening of the connective tissues of the eyelid frequently
contribute to this lax and redundant eyelid tissue. These findings are
more common in the upper eyelids but can be seen in the lower eyelids
as well."

"Some systemic diseases also may predispose patients to develop
dermatochalasis. These include thyroid eye disease, renal failure,
trauma, cutis laxa, Ehlers-Danlos syndrome, amyloidosis, hereditary
angioneurotic edema, and xanthelasma. Genetic factors may play a role
in some patients."

* Dermatochalasis can be a functional or a cosmetic problem for the
patients. *

"When functional, dermatochalasis frequently obstructs the superior
visual field. In addition, patients may note ocular irritation,
entropion of the upper eyelid, ectropion of the lower eyelid,
blepharitis, and dermatitis."

"When * cosmetic,* patients note a fullness or heaviness of the upper
eyelids, "bags" in the lower eyelids, and wrinkles in the lower
eyelids and the lateral canthus."

"Steatoblepharon describes the herniation of the orbital fat in the
upper or lower eyelids. It is associated frequently with
dermatochalasis. However, some patients may present with isolated
steatoblepharon. Herniation of the orbital fat in the eyelids is
because of a weakening of the orbital septum, usually because of age.
Most commonly, it is noted in the medial upper eyelid but can give the
appearance of "bags under the eyes."

"In the US, dermatochalasis most frequently occurs in elderly persons
and is very common; the severity is quite variable. The age of onset
most frequently is noted in the 40s and progresses with age. Some
patients have a familial tendency and develop dermatochalasis in their

A mild, but chronic Sinus Infection

"swelling of the lower eyelids, especially upon waking in the morning"
is one of the symptoms of an underlying sinus infection."

Refer to "Sinusitis," by Anthony W Chow, MD, FRCPC, FACP. Patient
Guide. June 2000.
for an overview.

 I mention this possibility due to personal experience. I had a mild
but chronic sinus infection for several years, though I felt none of
the usual symptoms such as headache or tenderness. However, my lower
eyelids were always puffy and swollen in the morning. (of course, they
don't look that great now, either, due to a roadmap of wrinkles AND
baggy skin!) I tried the same techniques you did, including ice packs
and sleeping with my head elevated.

 I finally went to a good Ear, Nose and Throat doctor who, although he
could not find any signs of infection, prescribed a medicine that
would allow my sinuses to drain. It worked very well, and I only used
the medicine for a short while.

 Because you had a somewhat serious infection in the past which caused
swelling under the jaw line, you might visit a very good ENT doctor.
Even though you have had the "mysterious" lump checked out, an ENT
might have some further insight into the reason why the lump is still
visible and whether it is impeding lymphatic drainage.


Mild allergies

Allergies often include itchy, red, or tearing eyes along with
puffiness or swelling. However, it is possible that you have a mild
allergy which only produces swelling.
Eyelid edema

 Eyelid edema is a condition where the eyelids contain excessive
fluid. Eyelid edema is most often caused by allergic reactions, for
example, allergies to eye makeup, eyedrops or other drugs, or plant
allergens such as pollen. However, swelling can also be caused by more
serious causes, such as infection, and can lead to orbital cellulitis
which can threaten vision. Symptoms can include swelling, itching,
redness, or pain.

From "Eyelid disorders."


"Allergies usually produce marked crinkly lid edema with hyphemia and
scaling of one or both eyes. The acute type, seasonal allergic lid
edema, is caused by a hypersensitivity to airborne pollens or direct
hand-to-eyelid application of pollens (eg, after working in the
garden). Chronic allergic reactions occur from contact sensitivity due
to topical drugs (eg, atropine, neomycin) or cosmetics or metals
(nickel) and perennial allergic lid edema, which is believed to be due
to a hypersensitivity to molds or to animal or dust mite dander."


 "In allergic lid edema, removal of the offending cause is often the
only treatment needed. Cold compresses over the closed lids may speed
resolution; topical corticosteroid ointments (eg, fluorometholone 0.1%
tid for not more than 7 days) may be needed if swelling persists."

From "Lid Edema." The Merck Manual of Diagnosis and Therapy.  


Lymphatic drainage

 You mentioned that the cosmetic surgeon thinks your swollen eyes
could be the result of a "lymphatic drainage problem." If so, I would
again recommend a visit to an Ear, Nose and Throat doctor for a proper

An extensive article about lymphatic drainage therapy mentions that it
can be a successful treatment for cosmetic problems, including
swelling of the lower eyelids.

"Esthetic: wrinkles (lymph drainage hydrates the skin, nurtures
wrinkles, removes toxins, regenerates skin tissue, tonifies skin,
relaxes facial muscles. . . .); skin complexion; erythrosis;
telangiectasia; hematosis; "bags" under the eyes."

DRAINAGE." Bruno Chikly, M.D.

A further excerpt from the article provides a brief description of
lymphatic therapy:

"Lymphatic Drainage is a specialized massage technique designed to
activate and cleanse the human fluid system. Because the lymphatic
system itself is responsible for optimum functioning of the water
circulation and immune system, Lymphatic & Energetic Drainage is a key
to maximizing our ability to rejuvenate and to establish resistance to
stress and disease."

"Lymphatic drainage was initially developed in Europe in 1932 by Dr. E
Vodder. By the late 60's it established the credibility necessary to
be taken seriously by the medical profession. Dr. Johannes Askonk, a
prominent German physician, then successfully tested 20,000 patients
in hospitals in order to verify its credibility, measure its
efficiency and find its indications and counter-indications."

"Today this technique is widely spread throughout Europe and is so
highly recognized in the medical field that doctors now commonly
prescribe these treatments which are used in hospitals and reimbursed
by Social Security. This work is facilitated by physiotherapists,
chiropractors, nurses and bodyworkers."

"Concisely we can say that the three main actions of lymphatic
drainage are:

 1) Stimulation of body fluid circulation. It activates lymph function
and lymph circulation. Indirectly stimulate the blood circulation of
the Body (enhance blood capillaries resorption, increase pulsation of
capillaries, activate venous circulation,..)

 2) Stimulation of the immune system: the passage of lymph in the
lymph nodes stimulate the immune system (the humoral as much as well
as the cellular immunity). The stimulation of lymph circulation
activate antigen/antibody presentation and immune reactions.

 3) Nervous system: stimulate the parasympathetic nervous system
(relaxation effect, antispastic effects -- muscle tonus -- , etc). The
constant stimulation of the C-fiber mechanoreceptors has inhibitory
effects (analgesi -anti-pain-action).


Additional Reading

Puffy eyes:
"Some individuals have persistently puffy eyes, whereas some people
find it to be an intermittent condition. There is no sure cure for
puffy eyes short of eyelid surgery. See the eyelid surgery entry in
the library for further information regarding this. Lack of sleep is
unlikely a significant factor for puffy eyes. If anything, sitting up
instead of lying down will help to prevent fluids from collecting in
the eyelid tissue. Sleeping with your head slightly elevated and being
sure to give your neck good support can help diminish fluid retention.
Alcohol consumption and a diet high in salt may help increase water
retention around the eyes. Contact lens irritation can also produce
swelling around the eyes. Exposure to smoke and rubbing the eyes as
well as allergens such as those found in makeup can help produce puffy
eyes. Leaving makeup on overnight can also exacerbate the situation.
Taking care to meticulously remove your makeup at night, and avoiding
rubbing the eyes as well as taking antihistamines for allergies is
very helpful. If you are sensitive to makeups, avoid them. Prevention
of using products which cause an allergic reaction is very helpful, as
is preventing dryness around the eyes. If dryness is a problem, using
a lightweight moisturizer is quite helpful. Putting eye gel in the
refrigerator to cool it is also an effective means for reducing the
swelling around the eyes. Certain patients benefit from mild oral
diuretics to help rid the water retention in the eyelids, which is a
common area for water retention. Don’t forget that surgery, whether it
be removing the fat or a procedure to tighten the skin such as laser
surgery or chemical peels, is the ultimate tool for reducing eyelid

Total Skin Care website: 


 I hope I have provided you with some concrete and useful ideas to
consider. If you rule out genetics and aging, and feel that the
swelling is the result of a medical condition, I again strongly
recommend that you see an Ear, Nose and Throat specialist. A good ENT
will be able to diagnose or eliminate sinus problems and allergies,
consider your past infection as a possible factor, and advise you on
the merits of lymphatic drainage. Once you have eliminated possible
medical causes for your swollen eyelids, you can then consider further
 cosmetic surgery if you desire.

One last thing.....

 I know you mentioned that ice does not reduce the swelling. Have you
tried "a wet compress of 4 tablespoons freshly grated raw potato,"
placed over the eyes for 15 minutes?!!!

 As one who can identify with your problem, I might have to give that
a try!!

I wish you the best!


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