A Swollen Eyelid in a Baby

When to get help

Call emergency services or go to an emergency department — 999 in the UK, 112 or 999 in Ireland and across the EU, 911 in the US and Canada, 000 in Australia, 111 in New Zealand — if your baby has a swollen eyelid with any of these:

• The eye looks pushed forward or bulging.
• The eyelid is swollen shut, or the swelling is spreading fast across the cheek or forehead.
• The eye does not move normally in all directions, or your baby will not open it at all.
• A fever with the swelling, or a baby who is drowsy, floppy or not themselves.
• The swelling followed an injury, a bite near the eye, or contact with a chemical.
• Swelling of the face, lips or tongue with difficulty breathing, which is anaphylaxis and needs an immediate 999 call.

Seek urgent same-day advice — NHS 111 in the UK, your GP or out-of-hours service in Ireland, your paediatrician in the US or Canada, healthdirect on 1800 022 222 in Australia, Healthline on 0800 611 116 in New Zealand — for any eyelid that is red, hot and tender rather than simply puffy, for swelling that is getting worse over hours, or for any significant eyelid swelling in a baby under three months.

The reason for the low threshold is that infection of the tissue around the eye can spread backwards into the socket, where it becomes serious quickly. The NHS advises urgent medical help for cellulitis around the eye, and in babies it is treated as a same-day problem rather than a wait-and-see one.

Puffy versus infected

Most swollen eyelids in babies are not infections. The useful distinction is temperature and colour.

A puffy eyelid that is soft, the same colour as the surrounding skin, not hot, present on waking and improving through the morning is usually fluid, position, crying or a mild allergy. Both eyes are often affected. Your baby is otherwise entirely well.

An infected eyelid is red or dusky, warm or hot to the touch, tender when you go near it, firm rather than squashy, and gets worse rather than better over hours. It is usually one eye. There may be a fever. That combination is the one that needs a doctor today.

The common causes

A blocked tear duct is extremely common in the first year and produces a watery eye with sticky discharge, sometimes with mild puffiness of the lid. The eye itself is white and your baby is comfortable. Most clear on their own during the first year with gentle cleaning and, if advised, massage over the inner corner.

Conjunctivitis makes the white of the eye pink or red with discharge, and the lids can become mildly swollen and crusted, especially after sleep. In a baby under one month old, any red or discharging eye needs assessing promptly rather than treating at home.

A stye is a tender red lump on the lid margin, and a chalazion is a firmer, painless lump within the lid that develops slowly. Both are localised. If the whole lid becomes red and swollen around one, the picture has changed.

Insect bites near the eye produce dramatic overnight swelling, often with the lid closing. They are itchy rather than tender and the skin is usually not hot. Because a bite and an early infection can look similar in a baby, a bite that is spreading, hot or accompanied by fever gets the same-day rule.

Allergic swelling tends to affect both eyes, is itchy, comes with sneezing or a runny nose, and comes on and settles quickly.

Why babies get a lower threshold

Small children have thinner tissue planes around the eye and a less developed immune response, so an infection that starts in the skin of the lid can move behind the eye faster than in an adult. Once it is behind the eye, it threatens the movement of the eye, the optic nerve and, rarely, spreads further.

The features that suggest it has gone deeper are the ones in the emergency list: the eye pushed forward, restricted movement, severe swelling, pain on moving the eye, and a systemic picture of fever and an unwell baby. Those are hospital signs, and treatment is intravenous antibiotics rather than drops.

What to do at home while you get advice

Clean any discharge with cooled boiled water and a clean piece of cotton wool for each wipe, going from the inner corner outwards, and use a fresh piece for each eye. Wash your hands before and after.

A cool, clean, damp cloth held gently against the lid for a few minutes eases swelling from a bite or a knock. For a stye, a warm compress a few times a day is the usual advice, but do not squeeze or try to lance anything.

Do not use leftover eye drops, drops prescribed for someone else, or over-the-counter drops in a baby without advice. Do not put breast milk, tea bags or any home remedy into a baby's eye. Take a photograph each morning if you are watching something over a couple of days — the change between photographs is usually what settles the decision.

Both eyes, or the whole face

If both eyelids are swollen, look wider. Generalised puffiness of the face, especially with swelling elsewhere, changes in nappies, or a baby who is unwell, needs a proper assessment rather than an eye appointment. Swelling that comes on rapidly with hives, vomiting or any breathing difficulty after a food, a sting or a medicine is an anaphylaxis question and an immediate emergency call.