Having dark circles under the eyes is a common cosmetic problem that many people encounter, regardless of age or gender, which can make us appear tired, sick, and older, and may significantly affect one's self-esteem. Dark circles under the eyes cause concern for many individuals, which may not indicate a medical issue; however, they may cause medical concern in some cases.
Dark circles under the eyes are also known as infraorbital dark circles or periorbital hyperpigmentation, which can be caused by various factors, from lifestyle choices to underlying health conditions.
Continue reading to explore the potential causes of dark circles and the management and treatment options available.
Causes of dark circles under the eyes
There are several common causes associated with dark circles under the eyes, including pigmentation and puffiness. From November 2009 to July 2011, an anonymous study was conducted on 200 new patients aged 16 to 45 who attended a teaching hospital in India to ascertain the cause of their periorbital hyperpigmentation. Among the risk factors and causes discovered, the study showed that the causative factor in 63% was genetics, and 40% was due to a lack of sleep.1
Most times, dark circles under the eyes are caused by a combination of factors, including: 1,2,3,4,5
- Genetics: some people’s genes make them prone to having dark circles under their eyes
- Ageing: the older one gets, the thinner the skin around the eyes becomes, and the fat and collagen in the eye area decreases, leading to dark circles. The severity differs according to each individual's ligament and bone structure
- Stress: Stress causes increased Melanocyte stimulating hormone (MSH) secretion through the hypothalamic-pituitary-adrenal (HPA) axis in response to stress, resulting in a vicious cycle. It is difficult to distinguish whether stress causes dark circles or vice versa, but once dark circles appear, they cause stress due to their aesthetic appearance. In the study of 200 patients, 71% reported stress due to their infraorbital dark circles
- Hormones: Hormones can cause or exacerbate dark under eye circles. Research shows that women who experience menstrual disturbances like irregular menstruation for periods of between 1.5 - 2 years and people taking antipsychotics, oral contraceptives, undergoing hormone-replacement therapy, or chemotherapeutic compounds are at risk of developing dark circles under the eyes
- Tear trough deformity: The tear trough is a concave deformity causing fat to bulge in the inner part under the eyes resulting from inherited differences in facial structure and ageing6
- Lack of sleep: fatigue, insufficient rest, or sleep deprivation can cause dark circles
- Allergies: allergic reactions cause inflammation, which can lead to the appearance of dark circles. Those who suffer from hay fever will notice under-eye "smudges" during allergy season. Some food allergies can also cause dark circles under the eyes
- Dehydration: insufficient water intake may cause the dilation of blood vessels around the eyes, leading to dark circles
- Excessive sun exposure: UV rays can cause the skin around the eyes to produce excess melanin, leading to dark circles
- Periorbital hyperpigmentation: a condition that results from excess melanin production in the skin
- Periorbital oedema: Water retention under the eyes due to leaky vessels can cause swelling and make the under eyes look darker than the rest of the face, also known as the shadow effect
Other factors like dermatitis, frequent eye rubbing, nasal congestion, eye drops, such as those used for glaucoma treatment, smoking, anaemia or iron deficiency, and poor blood circulation can also cause dark circles under the eyes.
Sometimes, dark circles under the eyes may indicate a yet-to-be-diagnosed chronic condition. Some medical conditions that may contribute to dark circles are heart, thyroid, kidney, or liver problems, vitamin K deficiency, and Addison's disease, among others.1
Management and treatment for dark circles
There are ways to manage and treat dark circles under the eyes. Some home remedies to manage dark circles include:3,4
- Getting adequate sleep: A healthy sleeping habit can facilitate the reduction of the appearance of dark circles
- Makeup: Concealers and foundation can help to mask the severity of dark circles, especially when used as colour correctors. Colour correcting is achieved using opposite colour wheel techniques and opposite hues. For example, green pigment is added to the base to reduce a reddened area, while orange is added to the base2
- Optical diffusers: Optical diffusers are made of fine mineral particles and are intended to reflect light away from the skin. Mica, polyurethane powder, silicone powder, talc, titanium dioxide, and zinc oxide are examples of optical diffusers used in camouflaging dark circles under the eyes2
- Cold compresses: These work to reduce the appearance of bulging blood vessels under the eyes
- Cucumber: Cucumber contains a high amount of water, vitamin C, and silica, which may help to soothe, calm, and nourish the eyes
- Facials: A gentle massage around the eye area during a facial can aid in circulation improvement for dark circles caused by poor circulation around the eyes
- Caffeine: When applied topically, caffeine can help to fade dark circles caused by bulging blood vessels, small widened blood vessels, and water retention caused swelling. A study found that a caffeine-based gel could penetrate the skin of the lower eyelid and reduce oedema (swelling caused by water retention) and pigmentation2
- Skincare products: Various eye creams from the beauty supply store can help to reduce dark circles by improving hydration and reducing inflammation. Eye creams that contain vitamin C and vitamin A derivatives like retinol help boost collagen production, reduce dark circles, and improve overall skin quality
- Tea bags: When cooled, tea bags can help to reduce puffiness and dark shadows
If the home remedies aimed to treat infraorbital circles do not help to improve their appearance, you can seek medical help from your doctor or dermatologist. Treatment is tailored to each patient, skin tone, and the underlying cause. Treatment can be topical, physical, or surgical and sometimes combine two or more treatment types.
Before the healthcare professional chooses a treatment option for you, they look out for some like characteristics associated with dark eye circles, which include the following:4
- Melanin presence, intensity, and extension
- Fat pads on the eyelids
- Excessive skin and changes in skin texture (lines and wrinkles) are present
- Tear trough deformity
- Small blood vessels under the skin
Treatment options carried out in a controlled and professional setting with topical medications and methods include:2,3,4
- Topical eye creams: Melanin pigmentation is known to be minimised by using products containing peptides, tretinoin, vitamin C, arbutin, hydroquinone (not to be used for more than three months), kojic acid, and azelaic acid7
- Chemical peels: Chemical peels help to improve the appearance of dark circles by removing the upper layers of skin and stimulating collagen production
- Dermal filler: In cosmetic dermatology, dermal fillers are commonly used to treat dark circles by restoring volume to the lower eyelid and reducing the appearance of hollowness under the eyes
- Laser therapy: laser therapy can help boost collagen production and promote skin cell regeneration, reducing dark circles
- Hyaluronic acid tissue filler: Hyaluronic acid (HA) fillers have become the treatment of choice to address under-eye shape defects that make the dark shading visible
- Fat transfer: Fat removed from a part of the body through liposuction is carefully injected into the affected depressed area under the eyes to reduce, improving the skin tone and texture
- Surgical implants: Tear trough implants and cheek implants have been successful in treating infraorbital dark circles by enhancing age-related soft tissue and bone loss
- Surgery: In severe cases, surgery may be carried out to remove excess fat and tighten the skin around the eyes
How can I prevent dark circles?
Several ways to prevent dark circles include getting sufficient sleep, hydration, eating a balanced diet, avoiding excessive sun exposure, and avoiding smoking and alcohol.
Who is at risk of dark circles?
Anyone can develop dark circles, but individuals with a family history of dark circles, advanced age, and individuals with underlying health conditions like eczema, dermatitis, and asthma have a higher risk of developing dark circles.
What vitamins are good for dark circles?
Vitamins that can help improve skin tone and reduce the appearance of dark circles include vitamins C, E, K, and B12.
Are dark circles permanent?
Dark circles are not always permanent and can be effectively treated with lifestyle changes and treatments.
When should I see a doctor?
Consult your doctor if you experience severe and sudden dark circles. Additionally, you should seek medical advice if you have dark circles associated with other symptoms, such as itching, swelling, or redness.
Dark circles under the eyes can be a cosmetic problem for many individuals and can be caused by several factors, including thin skin, pigmentation, sun exposure, and allergies. Treatments for dark circles include a combination of at-home remedies and professional interventions, such as eye creams, chemical peels, laser therapy, dermal fillers, and surgery.
Taking preventative measures like getting good sleep, staying hydrated, and avoiding smoking and excessive sun exposure can also help reduce the appearance of dark circles. You should seek medical advice if you experience severe and sudden dark circles or dark circles associated with other symptoms.
- Sheth, PratikB, et al. “Periorbital Hyperpigmentation: A Study of Its Prevalence, Common Causative Factors and Its Association with Personal Habits and Other Disorders.” Indian Journal of Dermatology, vol. 59, no. 2, 2014, p. 151. DOI.org (Crossref), https://doi.org/10.4103/0019-5154.127675.
- Vrcek, Ivan, et al. “Infraorbital Dark Circles: A Review of the Pathogenesis, Evaluation and Treatment.” Journal of Cutaneous and Aesthetic Surgery, vol. 9, no. 2, 2016, p. 65. DOI.org (Crossref), https://doi.org/10.4103/0974-2077.184046.
- Park, Kui Young, et al. “Treatments of Infra-Orbital Dark Circles by Various Etiologies.” Annals of Dermatology, vol. 30, no. 5, 2018, p. 522. DOI.org (Crossref), https://doi.org/10.5021/ad.2018.30.5.522.
- Goldman, Alberto, et al. “Periorbital Hyperpigmentation—Dark Circles under the Eyes; Treatment Suggestions and Combining Procedures.” Cosmetics, vol. 8, no. 2, Mar. 2021, p. 26. DOI.org (Crossref), https://doi.org/10.3390/cosmetics8020026.
- Mac-Mary, Sophie, et al. “Identification Of Three Key Factors Contributing To The Aetiology Of Dark Circles By Clinical And Instrumental Assessments Of The Infraorbital Region.” Clinical, Cosmetic and Investigational Dermatology, vol. 12, Dec. 2019, pp. 919–29. www.dovepress.com, https://doi.org/10.2147/CCID.S217956.
- Jiang, Jindou, et al. “Tear Trough Deformity: Different Types of Anatomy and Treatment Options.” Advances in Dermatology and Allergology, vol. 4, 2016, pp. 303–08. DOI.org (Crossref), https://doi.org/10.5114/ada.2016.61607.
- Sarkar, Rashmi et al. “Periorbital Hyperpigmentation: A Comprehensive Review.” The Journal of clinical and aesthetic dermatology vol. 9,1 (2016): 49-55. Pubmed Central. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756872/