30/08/2023
Dark circles under the eyes describe a common appearance of the lower eyelids that has various causes.
Increased pigmentation (melanin)😵
Loss of fatty tissue in the eyelid or around the eye🕴
Bulging fat and muscle loss🕴
Puffy eyelids👽
Pigmentation under the eyes is associated with dermal deposition of melanin.
Sun exposure🚫
Atopic dermatitis🛃
Contact dermatitis🚻
Rubbing or scratching the eyes.❌
What are dark circles under the eyes?
Dark circles under the eyes describe a common appearance of the lower eyelids that has various causes.
Increased pigmentation (melanin)😨
Loss of fatty tissue in the eyelid or around the eye😖
Bulging fat and muscle loss😳
Who gets dark circles under the eyes?
Those prone to dark circles under the eyes include:
The elderly (but they are also a common complaint in adolescents)
People of non-white ethnic background
People with a genetic predisposition to dark circles under the eyes.
What causes dark circles under the eyes?
Pigmentation under the eyes is associated with dermal deposition of melanin. Dermal melanin deposition is often due to post-inflammatory pigmentation, which may follow:
Sun exposure
Atopic dermatitis
Contact dermatitis
Rubbing or scratching the eyes.
Loss of fatty tissue in the eyelid or around the eye (tear trough) is associated with:
Ageing
Genetic factors
Smoking.
Bulging or puffy eyelids may be due to systemic conditions, particularly:
Thyroid disease
Dermatitis
Hay fever (allergy).
Thin translucent skin is commonly observed with:
Age
Genetic factors.
Shadowing is more noticeable at times, due to:
Fatigue or lack of sleep
Periorbital oedema (puffy eyelids)
Dehydration (sunken eyes).
Superficially located blood vessels and blood stasis may contribute to the darkened appearance.
How are dark circles under the eyes diagnosed?
Correct diagnosis of dark circles under the eyes can be difficult. It involves:
Personal, medical and family history
Physical examination
Wood lamp evaluation, which allows the clinician to assess the depth of pigmentation.
How are dark circles under the eyes treated?
Treatment of dark circles under the eyes depends on its nature. General measures include:
Adequate sleep
Smoking cessation
Sleep with extra pillows to elevate the head and reduce eyelid swelling
Massage temporary swelling while applying a cold compress
Cold compresses also minimise the appearance of prominent blood vessels
Cosmetic camouflage
Light-reflecting concealers (these are often yellow or gold in colour) covered by translucent face powder. These should be applied in the shadows, not on the puffy skin.
Medical treatments to reduce pigmentation can include:
Protection from sun exposure using sunglasses
Topical agents; however dermal pigmentation responds poorly, and eyelids are sensitive so the stronger products may irritate (see melasma)
Chemical peels to reduce fine lines and surface pigmentation
Laser or intense pulsed light (IPL) treatments.
