Persistent Eye Puffiness: Causes, Treatments, and Expert Insights

Eye swelling

I have been experiencing chronic swelling in my eyes, specifically only on the right side, which has caused my double eyelid to turn into a single eyelid.
I have seen over ten doctors; some suggested that it might be dry eye syndrome and prescribed artificial tears, but it hasn't helped, and my eye remains swollen.
Others indicated that it could be due to allergies and prescribed eye drops, but that did not reduce the swelling either.
Recently, I visited Chang Gung Memorial Hospital, where the doctor prescribed Zaditen Eye Drops 0.025%.
Initially, the drops helped reduce the swelling, but recently, my eye has started swelling again every day.
After using this eye drop, I sometimes experience stinging and discharge from my eye.
I have been consistently using the eye drops without stopping.
I also had my allergy levels tested, which showed a total of 57.2, and the lab technician said this is within the normal range, suggesting that my eye swelling may not be due to allergies, yet the doctors insist it is.
Additionally, I had my thyroid checked for hyperthyroidism, and the doctor mentioned that I have two small cysts on my neck, but they are benign, so there is no cause for concern.

Ami, 20~29 year old female. Ask Date: 2010/05/04

Dr. Hu Yusheng reply Ophthalmology

Dear Miss Ami,
You have been experiencing long-term swelling in your right eye, which has not improved despite being treated as an allergic issue, and thyroid hyperactivity has been ruled out.
It is recommended that you consult a physician to prescribe oral antihistamines to see if there is any improvement.
If there is improvement, it is likely an allergic issue.
However, if the improvement is limited, you should see a specialist in ocular pathology or orbital diseases to rule out other rare conditions.
Wishing you health and safety.

Reply Date: 2010/05/04

More Info

Persistent eye puffiness can be a frustrating and uncomfortable condition, especially when it seems resistant to various treatments. Based on your description, it appears that you have been experiencing chronic swelling in your right eye, which has led to changes in your eyelid appearance and has not responded well to several treatments prescribed by different doctors. Here, I will provide insights into potential causes, treatments, and recommendations based on your situation.

Causes of Persistent Eye Puffiness
1. Allergic Reactions: Although your allergy test results were within the normal range, it is still possible that you may have sensitivities to certain environmental factors, such as pollen, dust mites, or pet dander. Allergies can cause localized swelling and may not always show up in standard allergy tests.

2. Dry Eye Syndrome: Dry eyes can lead to irritation and inflammation, which may manifest as puffiness. If artificial tears have not provided relief, it may be worth exploring other treatments, such as prescription medications that increase tear production.

3. Thyroid Issues: Thyroid disorders, particularly hyperthyroidism or Graves' disease, can lead to eye-related symptoms, including swelling. Since you mentioned having small benign cysts in your neck, it would be prudent to monitor your thyroid function regularly, as thyroid imbalances can affect eye health.

4. Fluid Retention: Conditions that cause fluid retention, such as dietary salt intake, hormonal changes, or systemic issues, can lead to localized swelling around the eyes.

5. Infection or Inflammation: Chronic inflammation or infection (such as conjunctivitis or blepharitis) can cause persistent swelling. If there is any discharge or discomfort, this could indicate an underlying infection that may require specific treatment.

Treatment Options
1. Continued Use of Eye Drops: Since you have been prescribed Zaditen (an antihistamine eye drop), it is essential to continue using it as directed. However, if you experience stinging or increased discharge, consult your doctor, as this may indicate an adverse reaction or infection.

2. Cold Compresses: Applying a cold compress to the affected eye can help reduce swelling and provide temporary relief. This can be particularly effective if the swelling is due to inflammation or allergic reactions.

3. Consult an Allergist: Since multiple doctors have suggested allergies as a potential cause, consider seeing an allergist for a more comprehensive evaluation. They may conduct skin tests or recommend an elimination diet to identify specific triggers.

4. Thyroid Function Tests: Given your history of thyroid issues, ensure that your thyroid hormone levels are regularly monitored. If there are fluctuations, your doctor may adjust your treatment plan accordingly.

5. Lifestyle Modifications: Evaluate your diet and lifestyle for factors that may contribute to swelling. Reducing salt intake, staying hydrated, and ensuring adequate sleep can help manage fluid retention.

6. Follow-Up with an Ophthalmologist: If your symptoms persist despite treatment, it may be beneficial to see a specialist who can conduct a thorough examination, including imaging studies if necessary, to rule out any structural issues or other underlying conditions.

Conclusion
Persistent eye puffiness can stem from various causes, and it often requires a multifaceted approach to treatment. Since you have already consulted multiple doctors, it may be beneficial to seek a second opinion from a specialist who can provide a fresh perspective on your condition. Keep track of any changes in your symptoms and communicate these to your healthcare provider, as this information can be crucial in determining the most effective treatment plan. Remember, managing eye health is a collaborative effort between you and your healthcare team, and persistence in seeking answers is key to finding relief.

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