A swollen eye in an infant causes high anxiety for any parent, as it can signal a problem ranging from simple irritation to a serious infection. The delicate tissues around a baby’s eye are highly reactive, and swelling can appear suddenly. Because the causes vary widely, prompt evaluation by a medical professional is necessary to ensure the baby receives appropriate care.
Non-Infectious and Minor Irritants
Swelling around a baby’s eye does not always indicate a serious condition, as many common issues involve minor irritation or mechanical problems. A frequent cause is a blocked tear duct, known as dacryostenosis, which affects about six percent of newborns. Tears must drain through the nasolacrimal duct into the nose. When this duct is blocked, tears collect and back up, causing puffiness and often a mild, sticky, non-infectious discharge.
The swelling is usually most noticeable in the inner corner of the eye and may be intermittent. It often resolves on its own by the time the baby reaches one year of age as the duct matures. Positional swelling is also common, occurring when fluid accumulates in the eyelid tissues overnight. This puffiness quickly subsides after the baby wakes up and begins moving. Minor allergic reactions can cause localized swelling, typically in response to environmental triggers like dust or pet dander, or a reaction to a new soap or lotion. This reaction often presents with swelling in both eyes and sometimes a watery discharge, but lacks the thick, colored discharge of a bacterial infection.
Common Infectious Causes
Infectious agents frequently cause a swollen eye in infants, with conjunctivitis, or “pink eye,” being a common diagnosis. This condition is the inflammation of the conjunctiva, the thin membrane lining the inside of the eyelids and covering the white part of the eye. Conjunctivitis can be viral or bacterial, distinguished primarily by the type of discharge present.
Viral conjunctivitis is highly contagious and often accompanies an upper respiratory infection. It typically produces a watery discharge and may cause the eyelids to stick together upon waking. Bacterial conjunctivitis usually presents with a thicker, yellow or green discharge that causes significant mattering of the eyelids throughout the day. Both types cause the eyelids to become swollen, red, and itchy.
A stye, or hordeolum, is another localized infection. It is a tender, red bump caused by a bacterial infection of an oil gland at the edge of the eyelid. Styes only affect a small area of the eyelid and generally do not involve the entire eye or cause a systemic illness.
Serious Conditions Requiring Emergency Care
Certain causes of a swollen eye demand immediate medical attention due to the risk of vision loss or rapidly spreading systemic infection. Periorbital cellulitis is a serious bacterial infection involving the eyelid and surrounding skin, contained in front of the orbital septum. Symptoms include fever, a red, warm, and tender swollen eyelid, and general fussiness. Crucially, the eye itself appears normal, and there is no pain with eye movement.
Orbital cellulitis is a more severe, less common condition where the infection has spread behind the orbital septum into the eye socket. This is a medical emergency that can lead to vision loss, meningitis, or a brain abscess. Danger signs include a bulging eye, pain when the baby moves the eye, difficulty moving the eye, and changes in vision.
Severe trauma, such as a deep scratch or foreign object presence, also requires emergency care to assess for damage to the eyeball. A severe allergic reaction, known as angioedema, causes rapid swelling of the face and eyes. If accompanied by trouble breathing or swallowing, this is a life-threatening emergency.
Immediate Actions and Triage
When a parent notices eye swelling, the priority is careful observation and triage before seeking professional medical advice. First, monitor for signs of systemic illness, such as high fever, lethargy, poor feeding, or extreme irritability. It is also crucial to assess the affected eye for changes in vision, such as an inability to track objects, or an inability to open the eye due to swelling.
Parents should check if the redness extends beyond the eyelid or if the eye appears to bulge forward. If the swelling is mild and not accompanied by fever or behavioral changes, gentle cleaning can be performed. Use a clean cloth moistened with warm water to remove any crusting or discharge. For minor irritation, a small, cool compress applied gently without pressure can help reduce swelling and discomfort.
Immediate emergency care is warranted if the baby exhibits signs suggesting a potentially vision-threatening or life-threatening condition. These signs include a high fever, pain upon eye movement, any change in the eye’s position, or rapidly worsening swelling.