Puffy eyelids may have a systemic or local cause. There are several possible causes of eyelid puffiness: one is systemic, because the eyelid tissue is one of the most lax parts of the body, and edema caused by kidney disease, cardiac insufficiency, and hypoproteinemia due to malnutrition will first accumulate in the eyelid tissue and manifest as eyelid puffiness. This puffiness is bilateral and is usually more pronounced when waking up in the morning and decreases after a day of activity into the evening. Patients with these manifestations should be seen by an internist to investigate systemic disease. Second, there are local factors, such as eyelid allergy, chalazion or wheals. Allergy can manifest as eyelid edema in one eye or puffy eyelids in both eyes, and eyelid edema due to chalazion or wheals is usually monocular, and patients should be examined by an ophthalmologist for anti-allergy or anti-infective and anti-inflammatory symptomatic treatment for different etiologies. There are also non-disease factors, such as fatigue, excessive water or salt intake, and idiopathic eyelid edema, which is often seen in women and is related to endocrine hormone levels, that do not require special treatment and tend to resolve on their own with rest, adjustment of lifestyle habits, and emotional relief. In conclusion, patients with eyelid edema may have systemic or local diseases, or may be caused by non-disease factors, and should go to ophthalmology and related departments for examination to clarify the cause and take appropriate treatment.