If a patient has puffiness in the lower eyelids, there are usually several factors as follows: 1. Whether it is an allergic or infectious factor, if the patient has contact allergies, there will be puffiness in the eyes, especially around the eyelids. 2. Excluding infectious and allergic factors, the cause of puffiness in the lower eyelids may be renal insufficiency. In chronic renal insufficiency, there is hypoproteinemia, and the patient will have puffiness and 3. Patients with hypothyroidism may also have puffy eyelids and eyelids. 4. Patients with malnutrition may have puffy lower eyelids due to malnutrition. 5. Patients with chronic cardiac insufficiency, especially chronic heart failure, may also have puffy lower eyelids.