Periorbital dark circles, or infraorbital hyperpigmentation, are an inconvenience millions of people face every day and affect individuals across all age groups and ethnicities. Dark circles under the eyes are often perceived as a sign of fatigue, aging, or ill health. Despite social misconceptions, the causes are multifaceted. They may be pigmentation irregularities, vascular abnormalities, structural deficiencies, and lifestyle influences.
This article provides a detailed medical review of periorbital dark circles. We will focus on etiology, pathophysiology, differential diagnosis, and how to get rid of dark circles under the eyes.
Etiology and Pathophysiology of Dark Circles
The etiology of dark circles is complex. Find what causes dark circles under the eyes below:
1. Pigmentary Causes
Post-inflammatory hyperpigmentation (PIH)
Genetic predisposition
Sun exposure
Chronic rubbing, eczema, and atopic dermatitis can increase melanin deposition in the epidermal and dermal layers. Genetic factors play a role, too. Some individuals, especially those of South Asian, Middle Eastern, and Mediterranean descent, are genetically predisposed to high melanin production around the eyes. Meanwhile, ultraviolet (UV) radiation stimulates melanogenesis, further deepening skin discoloration and dark circles.
2. Vascular Causes
Thin periorbital skin
Venous congestion
Capillary fragility
The skin around the eyes is among the thinnest in the body (0.5 mm), so underlying blood vessels are more visible.
Poor lymphatic drainage, allergies, and sinus congestion can lead to blood pooling in the periorbital veins, thus the bluish-purple hue of dark circles. Capillary fragility, associated with anemia and vitamin K deficiency, can increase vessel permeability and hemoglobin degradation, resulting in hemosiderin deposition and visible discoloration.
3. Structural Causes
Tear trough deformity
Orbital fat herniation
Age-related volume loss in the periorbital fat pads can create a shadowing effect, exacerbating the appearance of dark circles under the eyes. Fat protrusion due to weakened septal support can create uneven light reflection, enhancing dark circle perception.
4. Systemic and Lifestyle Factors
Sleep deprivation
Smoking and alcohol consumption
Nutritional deficiencies
Reduced circulation and fluid retention cause periorbital puffiness and increased shadowing under the eyes. Smoking and alcohol contribute to oxidative stress, dehydration, and vascular compromise, intensifying dark circles. Last but not least, low levels of iron, vitamin B12, and vitamin K can impair oxygen transport and vascular integrity, worsening periorbital discoloration.
Differential Diagnosis: Is It Dark Circles?
Remember, not every skin pigmentation around the eyes is dark circles. Dark circles should be distinguished from other periorbital conditions with similar presentations:
Periorbital hyperpigmentation (due to melasma or dermal melanocytosis)
Dermatitis-related discoloration (atopic or contact dermatitis)
Infraorbital hollowing (age-related fat loss versus congenital factors)
Orbital lymphatic malformations (vascular malformations mimicking dark circles)
Systemic causes (anemia, hypothyroidism, adrenal insufficiency)
Diagnostic Approach to Dark Circles Under Eyes
History and Clinical Examination
A thorough clinical evaluation is essential for identifying the cause of dark circles under the eyes. Here is what the examination steps are:
Assess lifestyle, sleep patterns, family history, and systemic conditions
Examine pigmentation with a Wood’s lamp to differentiate epidermal from dermal pigmentation
Evaluate skin elasticity and volume loss through pinch tests
Imaging and Laboratory Tests
Imaging and laboratory tests can further investigate potential vascular or systemic contributions:
Dermoscopy
Optical coherence tomography (OCT)
Blood tests
Dermoscopy identifies vascular versus melanin-based pigmentation. OCT assesses periorbital skin thickness and vascular changes. As for blood tests, they tend to include hemoglobin levels, iron studies, and thyroid function tests. Blood tests can rule out systemic conditions contributing to dark circles.
RELATED: What to Expect During an Eye Exam?
Myths About Dark Circles Under Eyes
Myth 1: Dark Circles Are Always Caused by Lack of Sleep
One of the most widespread myths is that dark circles are always a result of insufficient sleep. While fatigue can make dark circles more noticeable due to fluid retention and paleness of the skin, it is not the primary cause in most cases.
Myth 2: Drinking More Water Will Make Dark Circles Disappear
Dehydration can cause the skin to look dull and less plump, which may make dark circles appear worse. Yet, drinking more water will not necessarily eliminate dark circles. No amount of water alone will resolve the deeper causes of dark circles under the eyes.
Myth 3: Cucumber Slices and Tea Bags Permanently Cure Dark Circles
Cucumber slices and tea bags are popular home remedies for dark circles. However, these remedies do not address the root causes of dark circles, and their temporary effects wear off quickly.
Myth 4: Laser Treatments Are Dangerous for Dark Circles
Laser treatments are often misunderstood and feared as harmful to the delicate under-eye area. In reality, when performed by trained professionals, laser therapy can treat dark circles from hyperpigmentation or vascular issues.
Myth 5: Dark Circles Can Be Completely Eliminated with Skincare Products Alone
While skincare can improve the appearance of dark circles, they are not a miracle problem solver. Especially if the pigmentation is due to genetic or structural factors. Retinoids, vitamin C, and caffeine can help brighten the area and stimulate collagen production, but they have limitations.
Evidence-Based Treatment Strategies for Dark Circles
Looking for efficient ways how to remove dark circles under the eyes? Instead of wasting your money on what the beauty industry promises but doesn't always deliver, here are a few evidence-based treatment options:
Topical Agents as a Supporting Treatment
Skin-lightening agents such as hydroquinone (2–4%), kojic acid, arbutin, and azelaic acid, are first-line treatments for periorbital hyperpigmentation. They work by inhibiting tyrosinase activity and reducing melanin synthesis.
Retinoids like tretinoin and adapalene promote dermal collagen production, thickening the skin and minimizing vascular visibility.
Antioxidants, including vitamin C and niacinamide, mitigate oxidative stress. What's more, peptides and growth factors aid in dermal remodeling, enhancing periorbital elasticity and firmness.
Since dark circles causes may differ in each person, please go for a dermatology and ophthalmology exam to find the root of the problem first. Self-diagnosing and self-treatment may worsen the problem. Only use topical treatments after a dermatologist's prescription or getting their recommendations.
RELATED: Are Cosmetic Eye Patches Safe?
Chemical Peels as a Supporting Treatment
Superficial chemical peels containing glycolic acid (20–50%), trichloroacetic acid (TCA, 10–20%), and lactic acid can help improve periorbital hyperpigmentation. These peels facilitate the exfoliation of pigmented keratinocytes, promoting skin renewal and reducing the intensity of dark circles.
Due to the delicate nature of periorbital skin, chemical peels should ONLY be administered by trained professionals.
Laser and Light-Based Therapies
Lasers offer targeted treatment for both vascular and pigmentary dark circles:
Intense Pulsed Light (IPL) reduces vascular dark circles by targeting oxyhemoglobin
Q-switched Nd:YAGÂ laser therapy treats dermal pigmentation
Fractional CO2 lasers enhance collagen remodeling and skin thickening, reducing the appearance of shadows around the eyes
Laser procedures should ONLY be performed by a certified dermatologist.
Surgical Interventions
For patients with significant structural abnormalities contributing to periorbital dark circles, surgical interventions may be a way out.
Blepharoplasty, a procedure that removes excess skin and fat pads from the lower eyelid, can improve the structural integrity of the periorbital region. Fat grafting or repositioning is another viable option to correct volume loss and enhance periorbital contour.
Blepharoplasty procedures should ONLY be performed by an ophthalmologist.
Lifestyle and Preventive Measures for Dark Circles
Adequate sleep regulates cortisol levels and betters microcirculation, while daily sun protection with SPF 30+ prevents UV-induced pigmentation. Dietary modifications, such as incorporating iron-rich foods, maintaining hydration, and consuming antioxidant-rich foods, support overall skin health and minimize the severity of dark circles.
In Summary...
Periorbital dark circles represent a complex interplay of genetic, vascular, structural, and lifestyle factors. A diagnostic approach with clinical evaluation and imaging modalities can determine the cause. Dark circle treatment should always be personalized.
External resources:
Infraorbital Dark Circles: A Review of the Pathogenesis, Evaluation, and Treatment; Ivan Vrcek, Omar Ozgur, Tanuj Nakra; PMCID: PMC4924417Â Â PMID: 27398005
Treatments of Periorbital Hyperpigmentation: A Systematic Review; 2021; Lauren Michelle, Delila Pouldar Foulad, Chloe Ekelem, Nazanin Saedi, Natasha Atanaskova Mesinkovska; PMID: 32740208 DOI: 10.1097/DSS.0000000000002484
✅ Medically reviewed
Checked by Atanas Bogoev, MD.