What is the treatment for a swollen eye?

Treatment for a Swollen Eye

The treatment for a swollen eye depends on the underlying cause, but generally begins with warm compresses, artificial tears, and eyelid hygiene, with additional targeted therapy based on the specific diagnosis.

Initial Assessment and Common Causes

A swollen eye can result from several conditions:

• Blepharitis (eyelid inflammation) - characterized by redness, crusting, and irritation along the eyelid margin 1
• Corneal edema - fluid accumulation in the cornea causing swelling 1
• Conjunctivitis - inflammation of the conjunctiva with redness and discharge 1
• Allergic reactions - causing periorbital edema and itching 2
• Infection (bacterial keratitis) - causing pain, redness, and corneal infiltrates 1
• Contact lens-related complications 1
• Medication reactions - certain drugs can cause periorbital swelling 3

General Treatment Approach

First-Line Treatments

• Warm compresses applied to the eyelids for several minutes to soften crusts, discharge, and warm meibomian secretions 1
• Eyelid cleansing with gentle massage using diluted baby shampoo or commercial eyelid cleaners 1
• Artificial tears for lubrication to reduce irritation and dilute inflammatory mediators 1

For Blepharitis

• Daily eyelid hygiene with warm compresses and lid massage to express meibomian glands 1
• Hypochlorous acid 0.01% eye cleaners which have strong antimicrobial effects 1
• Topical antibiotics may be needed if bacterial infection is suspected 1

For Corneal Edema

• Topical sodium chloride 5% drops or ointment to create a hyperosmotic effect 1
• Use of a hairdryer at arm's length to dry the ocular surface 1
• Bandage contact lens for painful bullous keratopathy, with prophylactic antibiotics 1
• Lowering intraocular pressure if elevated, avoiding prostaglandin analogues if inflammation is present 1

For Allergic Reactions

• Topical antihistamines such as ketotifen, administered as 1 drop in the affected eye(s) twice daily, 8-12 hours apart 4
• Cold compresses to reduce swelling and provide symptomatic relief 5
• Identification and avoidance of allergens 2

For Bacterial Infections

• Topical antibiotics - fluoroquinolones or fortified antibiotics depending on severity 1
• For severe infections: loading dose every 5-15 minutes followed by hourly applications 1
• Erythromycin ophthalmic ointment applied directly to the infected eye(s) up to six times daily for superficial ocular infections 6
• Cycloplegic agents to decrease pain and prevent synechiae formation when anterior chamber inflammation is present 1

Special Considerations

For Contact Lens Wearers

• Discontinue contact lens wear until the condition resolves 1
• Avoid pressure patching or bandage contact lenses after corneal abrasions due to higher risk of secondary infection 1

For Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

• Urgent ophthalmology review with daily follow-up during acute phase 1
• Daily ocular hygiene with gentle saline irrigation 1
• White soft paraffin ointment applied to the lips every 2 hours 1

When to Refer to an Ophthalmologist

Immediate referral is necessary when:

• Severe pain not relieved with topical anesthetics 5
• Vision loss 5
• Copious purulent discharge 5
• Corneal involvement or infiltrates 1, 5
• Traumatic eye injury 5
• Distorted pupil 5
• Herpes infection 5

Potential Pitfalls

• Misdiagnosis of periorbital edema - pure edematous swelling should not immediately be attributed to contact allergy without ruling out other causes 2
• Overlooking medication reactions - NSAIDs like ibuprofen and naproxen can cause periorbital edema 3
• Inadequate treatment of bacterial keratitis - can lead to permanent visual loss if not treated promptly 1
• Prolonged use of bandage contact lenses - increases risk of infectious keratitis despite antibiotic prophylaxis 1
• Confusing diffuse lamellar keratitis with infection after LASIK surgery, leading to inappropriate treatment 1