Why Your Eyelids Hurt: Common Causes and Treatments

Eyelid pain or irritation can have various causes, ranging from mild irritation to a severe infection. Common symptoms include redness, swelling, crusting of lashes, itching, or a gritty feeling. It’s important not to ignore these signs. If symptoms are severe or last more than a day or two, see your eye doctor for an exam – untreated eyelid problems can threaten vision or lead to complications. We hope that by the time you’ve read this brief post, you’ve identified the culprit and the following steps to soothe your sore eyelids.

1. Eyelid Infection (Cellulitis)

Bacterial eyelid infections are serious and usually worsen rapidly. Infections around the eye are called preseptal (periorbital) cellulitis when confined to the skin and eyelid, and orbital cellulitis when they spread behind the eye into the orbital tissues. Either can cause eyelid pain. Symptoms often include a red, swollen, and painful eyelid, accompanied by warmth to the touch. Orbital cellulitis (behind the eye) is especially dangerous – it can damage the optic nerve, lead to vision loss, or even spread infection to the brain.

Symptoms of peri-orbital cellulitis

• Painful swelling of the upper and/or lower eyelid
• Possible swelling around the eye, including the eyebrow and cheek
• Limited vision

Seek help if you’ve had a fever, vision change, or worsening swelling in an infected eyelid that needs emergency care. Prompt antibiotics (often by IV in the hospital) and sometimes surgery are required for orbital cellulitis.

Treatment of peri-orbital cellulitis

Preseptal cellulitis is usually treated with oral antibiotics under close supervision. Orbital cellulitis requires hospitalization, IV antibiotics, and sometimes surgical drainage to relieve pressure behind the eye. Do not delay – see a doctor if you suspect an eyelid infection.

2. Allergies

Allergic reactions often cause inflamed or itchy eyelids. In allergic conjunctivitis, exposure to pollen, dust, pet dander, mold, or other allergens triggers immune chemicals (histamine) in the eye tissues. This can cause your eyes to become red, watery, and itchy, and the eyelids may become puffy or swollen. Unlike infection, allergy symptoms usually affect both eyes and include clear (watery) tears rather than pus.

Common allergens

• Pollen (hay fever): Pollen grains easily become airborne and can land in the eyes, triggering histamine release. This can lead to itching, redness, tearing, and eyelid pain when the lids become inflamed from constant rubbing.
• Dust mites: Dust mite particles can irritate the eyes and surrounding skin.
• Animal dander: Proteins from pet dander can inflame the eyes and eyelids. This inflammation may cause itching, puffiness, and eyelid pain if exposure is frequent.
• Mold: Airborne mold spores irritate the eyes and can cause allergic swelling
• Smoke: Smoke is an irritant that increases inflammation and dryness.
• Eye cosmetics: Ingredients in mascara, eyeliner, and eyeshadow can trigger irritation or contact allergies. This often leads to swelling, redness, and eyelid pain when the delicate skin of the lids reacts.
• Contact lens solutions: Some solutions contain preservatives or chemicals that irritate the eyes and eyelids.

Allergy symptoms

Red or pink eyes, intense itching or burning, tearing, swelling of the eyelids, and possibly sneezing or a runny nose, if part of seasonal allergies.

Treatment of Allergies

Avoid the allergen when possible. Over-the-counter antihistamine pills or eye drops can greatly reduce itching and swelling. Short-term use of antihistamine or decongestant eye drops may relieve redness, but should not be used continuously for more than a few days. In all cases, don’t rub your eyes (which can worsen irritation). If OTC remedies fail, an eye doctor can prescribe stronger eye drops (e.g., steroid drops) or allergy shots.

3. Blepharitis (Eyelid Inflammation)

Blepharitis is chronic inflammation of the eyelid margins and eyelash follicles. It is very common and can make the eyelids red, swollen, and flaky. Blepharitis causes eyelids to become “red, swollen, or feel like they are burning”. Patients often feel a gritty or stinging sensation and may notice crusty debris on the lashes when they wake up. Blepharitis is usually not a serious condition, but it can cause your eyes to feel constantly irritated and may worsen dry eye symptoms.

Overgrowth of normal bacteria on the eyelids or blockage of the eyelid’s oil glands is most common. Skin conditions such as seborrheic dermatitis or rosacea, as well as clogged Meibomian glands, can also lead to blepharitis.

Symptoms of Blepharitis

Red, swollen eyelid edges; a burning or stinging sensation; eyelids may crust or stick together, especially on waking. Some people experience a feeling as if there is something in the eye (foreign body sensation). Blepharitis often causes oily flakes (like dandruff) on the eyelashes.

Treatment for Blepharitis

Hygiene is the key. Daily warm compresses (wet warm washcloth held over closed eyes for several minutes) help melt and remove greasy deposits. Gently scrubbing the lash line with diluted baby shampoo or eyelid cleansers removes flakes and oil. In stubborn cases, a doctor may prescribe antibiotic drops or ointment to be applied to the lid, or even oral antibiotics if necessary. With consistent care, symptoms usually improve over time.

4. Conjunctivitis (Pink Eye)

Conjunctivitis, often called pink eye, is an inflammation of the eye’s surface (the conjunctiva) that frequently involves the eyelids as well. Viruses, bacteria, or allergies can cause it. Conjunctivitis typically causes redness of the whites of the eyes, but it also irritates the eyelids.

Symptoms of Conjunctivitis

The symptoms vary depending on the cause. Bacterial conjunctivitis often produces a thick yellow or green eye discharge that crusts over the eyelashes in the morning. Viral conjunctivitis usually causes watery tearing and feels itchy or burning. Allergic conjunctivitis causes intense itchiness, redness, and a clear, watery discharge (often accompanied by other allergy symptoms). In all cases, the eyelids may swell and feel sore. Conjunctivitis signs can include eye redness, eyelid swelling, eyelid crusting, and an itching or burning sensation.

Treatment of Conjunctivitis

Viral conjunctivitis often resolves on its own in 1–2 weeks. Viral and bacterial pink eye are very contagious. They spread by hand contact, shared towels, or touching one’s eye and then another surface. Always wash your hands frequently and avoid touching your other eye. Home care (cool compresses, artificial tears) can ease discomfort. Bacterial conjunctivitis is treated with antibiotic eye drops, which usually clear the infection in a few days. (See a doctor if discharge is copious or if symptoms worsen.) Allergic pink eye is typically managed with allergy drops and avoidance of triggers. We recommend consulting an eye doctor if you experience severe eye pain, light sensitivity, blurred vision, or intense redness, as these may be signs of a more serious underlying issue.

5. Styes and Chalazia

A stye (hordeolum) is a common cause of acute eyelid pain. It is a localized bacterial infection of an oil gland at the base of the eyelashes, creating a red, tender bump on the eyelid margin. A stye is a painful red bump on the edge of your eyelid caused by a blocked gland.

Symptoms of Styes

• Localized swelling, pain, or tenderness at the site of the bump
• Tearing
• Pus that may discharge from the bump
• Often, the eyelid around a stye is swollen, and the eye may water or feel scratchy.

In contrast, a chalazion is a blocked Meibomian (oil) gland further back on the eyelid and is typically NOT infected. A chalazion may initially feel sore, but it typically becomes a painless, firm bump on the eyelid. A chalazion does not usually cause discharge or redness of the eye itself, but a large chalazion can distort vision by pressing on the eyeball.

Symptoms of Chalazion

• A small, painless bump on the eyelid (upper or lower)
• Firm, round lump that gradually appears over several days
• Mild eyelid swelling or fullness
• Tenderness early on (though most chalazions aren’t painful once formed)
• Redness around the lump
• Watery eyes
• Blurry vision if the bump presses on the eyeball
• Sensitivity to light (less common)
• Heaviness of the eyelid or feeling like something is in the eye
• Occasional discomfort when blinking

Treatment of Styes and Chalazias

Most small styes and chalazia resolve with home care. Apply a warm compress (clean washcloth soaked in warm water) to the area several times a day. This helps open the blocked gland, allowing the stye or chalazion to drain. Do not squeeze or pop it (that may spread infection). In most cases, a stye will burst and heal on its own.

If a stye or chalazion persists for more than a few weeks, schedule an appointment with an eye doctor. Medical treatment may include prescribed antibiotic ointments (for infected styes) or minor surgical drainage and steroid injection (for large chalazia). Both conditions are very treatable, and an eye specialist can safely relieve the bump.

6. Dry Eye Syndrome

“Dry eyes” primarily affects the surface of the eyeball, but it can indirectly cause eyelid discomfort. When tears are insufficient or evaporate too quickly, the eyes can become red, burning, and fatigued. Many people with dry eye feel their eyelids are heavy, tired, or irritated because their eyes are constantly strained to stay moist. Dry eye often accompanies chronic blepharitis or allergy as well.

Symptoms of Dry Eye

A dry, gritty sensation in the eye; stinging or burning; redness; light sensitivity; blurry vision that comes and goes. Paradoxically, watery eyes can occur as the tear glands overcompensate. If eyelid glands (Meibomian glands) are involved, the edges of the eyelids may also be inflamed (see blepharitis above).

Treatment for Dry Eye

At Dr. Brian Stephens, OD, with Barnet Dulaney Perkins Eye Center in Arizona, patients experiencing eyelid pain along with irritation, burning, or grittiness may have underlying dry eye linked to dysfunction of the meibomian glands. Dr. Stephens brings expertise in ocular surface disease and comprehensive eye care.

Treatment focuses on improving lubrication:

• Use over-the-counter artificial tear drops (preservative-free if used frequently) as the mainstay. Use them regularly throughout the day to keep eyes moist.

• At night, use a lubricating ointment to maintain moisture overnight.

• Other self-care measures include:

• Taking breaks from screens (the 20-20-20 rule: every 20 minutes, look 20 feet away for 20 seconds)
• Using a humidifier to add moisture to dry indoor air
• Wearing wrap-around glasses or moisture goggles in very dry or windy conditions
• Omega-3 supplements (fish oil) may help by improving tear quality for some patients.

Treatment for Severe or Chronic Dry Eye Syndrome

• An eye doctor can prescribe tear-stimulating eyedrops (e.g., drops containing Cyclosporine) to boost tear production and reduce inflammation.

• Other treatments include inserting tiny plugs in the tear ducts (Punctal plugs) to retain tears and increase lubrication.

• In cases where dry eye is driven by blocked or inflamed meibomian glands, in-office treatments such as intense pulsed light (IPL) and radio-frequency (RF) therapy may be recommended. IPL uses calibrated light pulses to reduce eyelid inflammation and improve oil flow from the glands, helping stabilize the tear film. RF therapy applies gentle heat to liquify thick gland secretions and stimulate healthier oil production, thereby improving tear film quality and reducing symptoms.

7. Eyelid Twitch (Myokymia)

Sometimes the cause of eyelid pain is actually a muscle spasm. Persistent eyelid twitching (myokymia) is usually benign and involves rhythmic spasms of the eyelid muscles.

Symptoms of Myokymia

Here are the common symptoms associated with eyelid myokymia:

• Fine, involuntary twitching or quivering of the eyelid (most often the lower eyelid).
• The twitching is typically unilateral (involving one eye) but can rarely involve both eyes.
• The contractions are described as intermittent, gentle “rippling” or “undulating” movements, rather than strong, forceful spasms.
• Duration can range from seconds to minutes, sometimes hours; in most cases, it resolves within days to weeks.
• Triggered or worsened by common factors like stress, fatigue, caffeine, lack of sleep, eye strain, and dry eyes.
• Usually, there is no associated pain, vision changes, or muscle weakness — the twitch is benign and isolated.

If eyelid spasms are persistent, severe, or accompanied by other symptoms (like eye redness or discharge), have a comprehensive eye exam. Rarely, involuntary eyelid closure (blepharospasm) can be a neurological condition, and this is relatively uncommon.

Treatment for Myokymia

• Remove or reduce trigger factors: get adequate sleep, limit caffeine and alcohol consumption, and manage stress and fatigue effectively.
• Lubricate the eyes if dryness or irritation is present: use over-the-counter artificial t+ears.
• Use warm compresses on the eyelid when twitching begins to help relax the muscle.
• Many cases resolve on their own within days to weeks without formal treatment.
• If the twitching lasts for several weeks or worsens, referral to an eye care specialist is indicated. In more persistent cases, injections of OnabotulinumtoxinA (Botox®) into the eyelid muscles may be used to block nerve signals and reduce the spasms.
• Rarely, if an underlying neurological or structural cause is present, surgical intervention may be required.

Schedule an Eye Care Appointment

Persistent eyelid pain or discomfort should not be ignored. Many eyelid conditions can be effectively managed once they are correctly diagnosed. If you notice any ongoing redness, swelling, discharge, or visual changes, contact your eye doctor immediately. Many problems (like infections or severe allergic reactions) require prompt treatment.

The ophthalmologists at Barnet Dulaney Perkins Eye Center specialize in comprehensive eye care and can determine the cause of your eyelid pain. We recommend scheduling an exam if symptoms persist or worsen. Early diagnosis means faster relief and protects your vision. Call Barnet Dulaney Perkins Eye Center or request an appointment online today to have your eye and eyelid issues evaluated and treated by our expert team.