Yes, heart or kidney disease can help cause “bags under the eyes.” And puffy eyes may actually be the first sign of a medical problem.

That’s because puffy eyes often become more noticeable with any condition that causes fluid retention. Liver disease, kidney problems or heart failure are potential culprits. Any medicine that causes you to retain fluid may make puffy eyes get worse as well.

Here are some other causes of bags under the eyes:

• Normal aging. The skin around the eyes is normally thinner and looser than skin elsewhere on the body. As we age, it becomes even looser and thinner. This allows fluid to collect, causing a puffy appearance. Veins under the skin can create the dark appearance of the skin.
• Sleep position. Lying horizontal can make it easier for fluid to collect beneath the eyes. It can also dilate the veins under the eyes, which darkens the appearance of the skin even more.
• Nasal congestion. Veins around the eyelids may drain into the nose. Nasal congestion or seasonal allergies also cause the veins under the eyes to dilate. 
• Genetics. An inherited tendency to have puffy eyes.

Contrary to popular belief, having bags under the eyes is not a reliable indication of being tired or sleepy.

What can you do about it? 

The standard recommendations are to get plenty of rest. And to get treatment for any medical condition that may be contributing to the problem.  

Topical treatments, such as moisturizers and vitamins, may help. Other options include makeup, laser treatments and cosmetic surgery. Placing cucumbers over the eyes is an unproven remedy. But it’s unlikely to make things worse. 

As puffiness under the eyes may be a normal part of aging, there is one more option: acceptance.