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Ask Dr. Dan B. Your Own Question
Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3343
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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I have puffy eyes that change day to day....also bloodshot

Customer Question

I have puffy eyes that change day to day....also bloodshot eyes very often..especially indoors w/ recycled air..and skin under eyes very dry. I dont eat salt, head elevated when sleeping, drink lots of water. I'm thinking something internal maybe?? what kind of doctor may be able to help me? any ideas what it could be?
Submitted: 6 years ago.
Category: Eye
Expert:  Dr. Dan B. replied 6 years ago.

Hello and thanks for your question. When someone has puffy eyes, this can be due to several reasons. One cause is just having an incompetent orbital septum which is a fibrous tissue that holds back the fat and tissues that surround the eyeball in the orbit, which enables this tissue to pooch out. This is very often a genetic or inherited feature that can be seen in other relatives.

Another cause for this can be a thyroid problem which is best noticed by observing the degree to which the eyes protrude from the orbit. If you have very prominent eyes (they protrude from the orbit a significant amount), then this may certainly be a possibility for your puffy and bloodshot eyes. The interesting thing about thyroid eye disease is it can be present no matter what level the thyroid hormones are at: hypothyroid, hyperthyroid, or even euthyroid (normal thyroid levels). Signs of hyperthyroidism include anxiety, tremulousness, heat intolerance, increased sweating, decreased or no menses, weight loss (can happen despite an in increased appetite) and increase in bowel movements. Hypothyroid signs include constipation, carpal tunnel syndrome, increased fatigue, cold intolerance, dry skin, deepening of the voice, brittle hair and hair that falls out easily, increased weight, depression, and puffy eyes. It does seem counter-intuitive, but you can have positive thyroid auto-antibodies (which are not commonly tested when investigating for thyroid disease) and therefore thyroid eye disease can exist even in the face of "normal" thyroid studies. It becomes a clinical diagnosis based on your symptoms and the signs in the eyes and possibly CT imaging of the eyes. There is usually an active phase of thyroid eye disease that occurs for approximately 1-2 years in most people, after which time it usually is quiet. During that time, however, the eye can become quite dry due to exposure, there can be double vision and even damage to the optic nerve if the swelling of eye tissues is severe enough. Your symptoms do sound consistent with this.

Another reason for puffy eyes is an inflammation of the eyes which is most commonly related to allergies; this usually causes itching of the eyeballs and also tends to make the skin around the eyes dry, flaky and itchy.

I do think you should see an ophthalmologist to determine which of these problems may be causing your symptoms because the treatments certainly can vary.

Does this information help address your concerns? Does this make sense? Do you have any other concerns that I haven't addressed?

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My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor