Dark circles under 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. The dark appearance can be due to:

• Increased pigmentation (melanin)
• Loss of fatty tissue in the eyelid or around the eye
• Bulging fat and muscle loss
• Puffy eyelids
• Thin, translucent skin
• Shadowing due to anatomic shape of the orbit

The appearance can be challenging to treat.

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.

Unfortunately, many of the remedies on the market lack evidence of efficacy.

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.

Loss of tissue (hollowing) and tear trough can be managed by aesthetic medical and surgical procedures:

• Fillers (dermal implants) eg hyaluronic acid injections or fat grafts
• Surgery to remove excess fat, muscle and skin (surgical blepharoplasty or laser eye-lifting procedure).

Considerable training and experience are required to optimise results. Improvement may be partial. An incorrect technique may make the dark circles look more prominent than before the procedure.