Allergic Reaction: This is often the most common cause of peri-orbital puffiness, especially if it's accompanied by other symptoms like itching, redness, and tearing. Allergies to pollen, dust, or certain products can lead to this condition.

Fluid Retention: Conditions that cause fluid retention, such as premenstrual syndrome, pregnancy, or certain medications, can lead to puffiness around the eyes.
Sinusitis: Inflammation of the sinuses can cause swelling and puffiness around the eyes due to the proximity of the sinuses to the orbital area.
Dermatitis/Eczema: Skin conditions like dermatitis or eczema can cause inflammation and puffiness around the eyes.
Sleep Deprivation: Lack of sleep or poor sleep quality can lead to fluid accumulation and puffiness under the eyes.

Thyroid Eye Disease: Although less common, thyroid eye disease (associated with Graves' disease) can cause significant peri-orbital puffiness and is critical to diagnose due to its potential to lead to serious complications like vision loss.
Cellulitis: Bacterial infection of the skin and subcutaneous tissues can cause severe swelling, redness, and warmth around the eyes, requiring prompt antibiotic treatment.
Angioedema: A severe, potentially life-threatening allergic reaction that can cause rapid swelling of the face, including the area around the eyes.

Wegener's Granulomatosis: A rare autoimmune disorder that can cause inflammation of the blood vessels, including those around the eyes, leading to puffiness and other symptoms.
Sarcoidosis: A condition characterized by the growth of granulomas (inflammatory cells) in various parts of the body, including the skin around the eyes, which can cause puffiness.
Amyloidosis: A group of diseases that result from the abnormal accumulation of amyloid proteins in various tissues, which can lead to peri-orbital puffiness among other symptoms.