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Your toddler went to bed last night looking like their typical adorable self, but woke up this morning looking like they snuck out for a round of toddler fight club while you were sleeping. One of their eyes is puffy or swollen, and you have no idea why. Is this a “take them to the ER in their pajamas” problem or a “wait and see what happens” problem?

First off, don’t panic. There’s probably a reasonable, not-serious explanation for why your child has a swollen eye (or two!). These can range from insect bites to blocked tear ducts to the dreaded pink eye. But since most parents aren’t pediatricians, it can be hard to figure out what’s behind your child’s swollen eye and even tougher to decide what exactly to do about it.

Here are all the reasons — common and uncommon, minor and serious — that your toddler might have a swollen eye, plus how you can do some detective work to figure out what’s going on.

A note for clarity

Just a heads up! This article mainly focuses on situations when the areas around your child’s eyeball (eyelids and tissues surrounding the eyes) are swollen. If your kiddo’s actual eyeball looks swollen, it will often have different causes and you’ll want to make an urgent appointment with a healthcare professional.

Living the toddler life is hard: Your brother won’t share his toys with you, your mom is always giving you the blue cup instead of the red one, and every time you ride your bike in the driveway, you skin your knee.

You sometimes spend a lot of your day crying, wondering what it feels like to poke yourself in the eye (okay, well, that hurts), and rubbing your eyes with dirty hands because who has time for soap and water?

The point? Little kids have plenty of reasons to wake up with a swollen eye. If you noticed your child rubbing their eye a lot the day before, or they just had one tantrum after another, the cause of the swelling could be as simple as that.

Check to make sure there’s nothing stuck in there, offer an ice pack, and give them a little extra TLC.

Conjunctivitis, also known as pink eye, is an inflammation of the inner eyelid and the membrane covering the eye (the conjunctiva). It can be caused by many things, including viral and bacterial infections, allergies, and abrasions.

Most common types of pink eye aren’t serious unless left untreated for awhile, so if your child has any of the typical symptoms — like itching, crusting, yellow discharge, or redness in the whites of the eyes — call your doctor for next steps.

If the pink eye is bacterial, it can be treated quickly with antibiotic eye drops. Most other causes of pink eye will respond to home remedies after 1 to 2 weeks.

Seasonal, environmental, or contact allergies can cause swelling of the eyes, along with redness, dryness, itching, and a gritty feeling.

If your child has known allergies — whether it’s to pollen, mold, pet dander, or a certain laundry detergent and they were recently exposed to their trigger — their swelling may be due to an allergic inflammatory response. It’s more likely that both of their eyes may be swollen if the cause is some kind of environmental allergen.

Call your child’s pediatrician to see if they would recommend giving your child Benadryl to combat allergies. Doses can usually be given every 4 to 6 hours and measured based on your child’s weight. They may also recommend alternative options, based on your child’s situation.

One thing to note: Anaphylaxis is a severe allergic reaction that can cause swelling of the eyes, but it won’t be the only symptom your child has. Typically, other parts of the face will also swell and it may become difficult for your child to breathe or swallow.

If your child has signs of anaphylaxis, you should seek immediate medical attention.

If your child is prone to mosquito bites, no part of their body is off-limits to these little bloodsuckers, including your child’s eyes. Since the eyelids and the tissue around the front of the eye are delicate, it’s common for them to swell up quite a bit with any type of insect bite — be it from a mosquito, gnat, fly, or even spider.

For bug bites that are swollen and itchy, you can ask your child’s doctor if they recommend giving Benadryl to your toddler orally. You may also be able to apply some topical Benadryl, too, but it really depends on where the bite is — you don’t want to get any in their eye.

If at any point your child’s insect bite looks like it is becoming infected, you should call or make an appointment with your child’s pediatrician instead of continuing to treat it at home.

Cellulitis is a serious infection and inflammation of soft tissue. It can happen anywhere in your body. When it happens to the tissue around your eye, it causes severe swelling, redness, and pain and puts your eyesight at risk.

Orbital cellulitis is an infection of the tissue behind the eye, while preseptal cellulitis is an infection of the tissue in the eyelid or the front of the eye. Both types of cellulitis are caused by bacteria. If your child has had a recent eye injury, bacteria can enter through openings in the tissue.

Other than a swollen eye, there are a few other key symptoms to look for, like:

  • eye pain or pain around the eye
  • fever of more than 100.4°F (38°C)
  • red upper and lower eyelids
  • skin around the eye that’s warm to the touch
  • sudden vision problems
  • an eye that looks bulgy in the socket
  • pupil changes

If your child’s swollen eye comes with any of these other serious symptoms, you should get them immediate medical care. Because cellulitis is an infection, it needs to be treated with antibiotics quickly.

Styes are uber-annoying but harmless infections of the eyelid glands, causing small, tender, red bumps. In toddlers, a stye might also cause some localized swelling.

A traditional stye appears on the outside edge of the eyelid. Sometimes the stye leads to something called a chalazion, which usually appears on the upper eyelid as a result of the blocked gland.

Either way, the treatment is the same: frequent warm compresses and gentle massage to loosen the blockage. Also gently wash or clean your toddlers hands and face regularly, and try to distract them into doing something else if you see them rubbing their eye.

If the stye or chalazion sticks around for more than 1 or 2 weeks or gets worse, make a doctor’s appointment to have it checked out.

Did your toddler’s older sibling whack them “accidentally” with a favorite toy yesterday? Eye injuries are a major cause of swelling, and the injury can look worse than it really is in little kids. If your child’s eye area also looks bruised or there’s a visible injury (like a cut or scratch), chalk it up to a contact injury.

Most of the time, these can be treated at home with ice packs, cool compresses, and over-the-counter pain relievers. But if you think your child’s actual eyeball was damaged (they scratched their cornea, for example), or they have significant pain or bleeding, you should take them to see their pediatrician or a pediatric eye doctor.

Nephrotic syndrome is an uncommon form of kidney disease that can affect children. It causes a host of symptoms, although it doesn’t usually affect the eyes directly. However, it can cause edema, or fluid retention, in various parts of the body, including the eyes.

While this is probably not the cause of your child’s swollen eye, they should be evaluated by their doctor and their kidney function should be checked if they have other symptoms like:

If your toddler does have childhood nephrotic syndrome, they will be referred to a renal specialist (pediatric nephrologist) for treatment and care. This condition typically goes into remission (is undetectable) as your child gets older and doesn’t return in adulthood.

Some of your child’s sinus cavities are located near their eyes. So a sinus infection can cause some mild puffiness of one or both of the eyes. But rarely a sinus infection can lead to cellulitis in small children, so make sure to keep an eye out for the following:

  • severe swelling
  • redness of the eyelids
  • any of the other typical cellulitis symptoms (as mentioned earlier)

As long as the sinus infection isn’t advanced, it can be treated with oral antibiotics, NSAID pain relievers, and home remedies to relieve symptoms.

A swollen eye is a pretty vague symptom that can signal anything from a totally minor annoyance (like a bug bite) to something more serious (like cellulitis).

So it’s hard for parents to know whether their child’s swelling is worth a call to the pediatrician or, in some cases, if it warrants a late-night visit to the closest urgent care center or emergency room.

Here are the signs that a swollen eye can’t or shouldn’t be treated at home, including how urgently you should respond.

Call your child’s doctor ASAP if:

  • the skin around your child’s eye is red and warm to the touch
  • they’re running a fever of 100.4°F (38°C) or higher
  • one or both eyes are swollen shut
  • they can’t move their eye easily to track an object
  • they’re tell you that they can’t see clearly or that colors look different than usual

Seek emergency medical care if:

  • the eyeball is bulging from the socket
  • your child is complaining of severe eye pain
  • your child is also having trouble breathing or swallowing
  • your child breaks out in hives
  • other parts of your child’s face are swollen or puffy
  • your child has facial pain and significant discharge with their swollen eye

Remember that if you aren’t sure whether or not your child’s swollen eye is serious, you can always call your child’s doctor and ask. Most pediatricians have 24/7 on-call staff who can advise you on the next steps. These might include treating it at home with a warm compress, calling back for an appointment first thing in the morning, or heading straight to urgent care.

Most causes of swollen eyes aren’t serious and will resolve easily with home remedies. But sometimes swelling is caused by eye infections that need to be treated by a doctor ASAP.

If your child wakes up one morning with a swollen eye, try ruling out more common causes — like styes, insect bites, and pink eye — before assuming the worst.

Serious eye infections are usually accompanied by pain, fever, redness, and vision changes. Severe allergic reactions will usually cause swelling in other parts of the face (not just the eye).

If your child has any of these symptoms with their swollen eye, you should call your child’s pediatrician right away. And if you can’t speak with a healthcare professional or make an appointment, consider taking your child to an emergency care center.