Diseases that cause dark circles around eyes

Raccoon eyes are dark purple or blue bruises under your eyes. The name comes from their resemblance to the dark circles under a raccoon's eyes.

Doctors sometimes call raccoon eyes periorbital ecchymosis. "Periorbital" means "around the eyes." "Ecchymosis" is a change in color.

Raccoon eyes can appear after an injury or illness that causes tiny blood vessels to bleed into the skin under the eyes. They're not the same as the dark circles you get when you're tired. Those dark circles are much milder and aren't from a medical condition.

Raccoon eyes are a symptom, not a disease. They aren't dangerous themselves, but they could be a sign of a serious head or eye injury. Consult a doctor, and do that right away if you’ve recently had an injury.

Show Sources

SOURCES:

American Academy of Ophthalmology: "Evaluation and Management of Orbital Hemorrhage."

Amyloidosis Foundation: "Symptoms."

BMC Nephrology: "A 64-year-old woman with raccoon eyes following kidney biopsy: a case report."

BMJ Case Reports: "Spontaneous periorbital ecchymosis: a rare presentation of acute lymphoblastic leukaemia."

Case Reports in Gastroenterology: "Periorbital Ecchymosis (Raccoon Eye) and Orbital Hematoma following Endoscopic Retrograde Cholangiopancreatograpy."

Dark circles under the eyes are commonly caused by thinning skin or from swelling and enlarged blood vessels.

Dark circles often develop when you haven’t slept in a while. Lack of sleep can also cause puffiness, or “eye bags,” under your eyes. Allergies are another common cause of dark circles. Others include trauma to the eye, low thyroid levels, and loose skin around the eyes.

Some people are more likely to get dark circles under their eyes due to genetics. In people with darker-toned skin, under-eye circles may be caused by a true darkening of skin pigment in the area, which is a condition called periorbital hyperpigmentation.

Risk factors for dark circles:

• Chronic insomnia
• Allergies
• Older age
• Darker skin

Many treatments for dark circles are simple, such as getting more sleep and applying creams to help firm and brighten the under-eye area. Stronger treatments, including chemical peels and laser therapy, may be recommended by your dermatologist.

Pro Tip

When you use skin creams with hyaluronic acid or hydroquinone, be careful not to get them in your eyes! If you do, please get medical attention. —Dr. Ben Hagopian

Common causes of dark circles

1. Fatigue

Symptoms

• Dark circles under the eyes
• Puffiness around the eyes
• Low energy

When you’re really tired (or you’re rubbing your eyes a lot), excess fluid may accumulate under your eyes or the blood vessels under your eyes may swell. This can cause light to reflect off the area in a way that makes it look like you have dark under-eye circles.

Treating fatigue

Getting more sleep can help relieve dark circles. Make sure you stick to a regular bedtime and wake-up time, limit alcohol and caffeine, and turn off screens an hour before you go to bed.  If you're struggling with chronic insomnia, online programs that teach cognitive behavioral therapy for insomnia (CBT-I) may also help.

For a quick and temporary fix for your dark circles, apply a cold pack or an ice cube to the under-eye area to help constrict swelling and reduce the appearance of dark circles. You can also use under-eye concealer to camouflage them.

2. Allergies

Symptoms

• Dark circles under the eyes
• Itchy, watery eyes
• Runny nose
• Sneezing
• Nasal congestion

Seasonal allergies are common and may cause “allergic shiners,” which are dark circles under the eyes caused by swelling of the area and dilated (enlarged) veins. This usually happens in the spring or autumn, when you’re exposed to triggers like grasses, pollen, and certain flowers. In autumn, ragweed is notorious for causing sneezing, itchy eyes, and nasal congestion.

Allergies usually get better in the winter, but they may occur year-round if you have indoor allergy triggers, such as pet dander or dust.

Treating allergies

Treatment for allergies starts with avoiding or removing your triggers. If that’s not possible, try using an over-the-counter (OTC) steroid nasal spray (like Flonase or Nasacort) or an OTC non-drowsy antihistamine (like loratadine or fexofenadine). These medications should help control your allergies and reduce your dark circles. If they don’t, see your doctor.

Dr. Rx

Many times, a patient will be quite tired or have poor sleep hygiene or be dealing with a major stressful event: new baby at home, work stress, etc. I’ll also ask about symptoms of allergies: Sneezing, runny nose, itchy or watery eyes. And I’ll listen for a congested sounding voice. —Dr. Hagopian

3. Aging

Symptoms

• Eye bags
• Dark spots from sun exposure
• Sagging skin

As you age and are exposed to sun over time, your skin loses firmness, becomes thin, and starts to sag, including under your eyes. The dark circles are usually from sagging or thinning skin rather than a change in your skin’s pigment. It can affect the way light reflects off your skin, making it appear darker. Long-term sun exposure can also cause skin pigment changes.

Treating age-related loose skin

Prevention is the best treatment for loose skin. Limit sun exposure, wear a wide-brimmed hat, hat, and apply broad-spectrum sunscreen with an SPF of at least 30.

To improve the appearance of loose skin, try using skin creams designed to give your skin more volume and firmness. Creams that contain hyaluronic acid may be particularly helpful. Or, your doctor may prescribe a skin cream containing retinoids, which helps diminish signs of aging, such as dark circles.

If the dark circles really bother you, see a dermatologist. Procedures such as chemical peels, laser therapy, fillers (such as Juvederm), and surgery can make dark circles less noticeable.

4. Hypothyroidism

Symptoms

• Puffiness under the eyes
• Fatigue
• Hair loss
• Difficulty concentrating
• Constipation
• Weight gain

Hypothyroidism is when your thyroid doesn’t produce enough thyroid hormone. It’s often due to an autoimmune disorder that causes your immune system to attack your thyroid gland. Sometimes it can occur after thyroid surgery.

Hypothyroidism is much more common in women than men. Risk factors include older age (60+), a family history of thyroid disease, and having been pregnant or delivered a baby in the prior 6 months.

Treating hypothyroidism

Hypothyroidism is treated with synthetic thyroid hormone pills. This can reduce dark circles under your eyes.

5. Periorbital hyperpigmentation

Symptoms

• Dark circles under the eyes

Periorbital hyperpigmentation is common in dark-skinned people. The circles are caused by an increase in pigmentation under your eyes. You may have it on or around one or both eyelids, or in the under-eye area. There are several causes of periorbital hyperpigmentation, including genetics and inflammation.

Treating periorbital hyperpigmentation

Treatment may include prescription or OTC skin-lightening creams like hydroquinone on the affected area (be careful not to get them in your eye!). Skin fillers can be injected into the skin to give the skin more fullness. Unfortunately, no treatment for periorbital hyperpigmentation has been proven to provide long-term satisfaction.

Less common causes of dark circles under the eyes

• Bruising: You may develop bruises around your eye if you’re hit in the eye or get injured during a fall.
• Dermatomyositis: This is an uncommon autoimmune disease that can cause a dark red or purple rash around your eyelids that may look like dark circles.
• Anemia (low red blood cells): Rarely, anemia can cause puffiness under your eyes. The condition is often caused by menstrual blood loss or other sources of bleeding.
• Swelling of the entire body: Widespread swelling caused by illnesses, such as liver disease, may cause swelling around the eyelids.

Eye bags in children

In children, allergies are a common cause of dark circles under the eyes. Fatigue is less likely to be the culprit, since most kids get enough sleep.

Pro Tip

If you get a lot of sun exposure, regular sun protection (sunglasses, hats and/or sunscreens with SPF 30 or higher) will help too. —Dr. Hagopian

Getting rid of dark circles

Health routine adjustments

• The best thing you can do is to get more sleep.
• For quick but temporary relief, place a cold pack or ice under your eyes to constrict the blood vessels.
• Avoid smoking and sun exposure, both of which prematurely age the skin and contribute to sagging and dark circles.

Over-the-counter products

• If your dark circles are caused by allergies, try to avoid or remove your triggers. You can also use OTC antihistamines or steroid nasal sprays. These reduce the swelling that occurs with allergies.
• For sagging eyelids, volumizing skin creams, such as those with hyaluronic acid, can be helpful.
• If you have periorbital hyperpigmentation, skin-lightening creams and concealer can help diminish dark circles.
• Use a concealer.

Special procedures and treatments

If you want a stronger treatment than creams, your dermatologist may recommend in-office procedures to help reduce dark circles, such as:

• Fillers: Dermal fillers (there are different kinds) are injected into the skin to give it more fullness, changing the way light reflects off your skin
• Laser treatments: Light energy is directed at the skin to destroy the outer layer and stimulate the lower layer to produce collagen, resulting in more skin fullness
• Chemical peels: A doctor applies a chemical solution to remove the outer darker layer of skin or applies a bleaching agent directly to the dark areas.
• Plastic surgery: A doctor can perform cosmetic surgery to lift sagging skin, reducing the dark circle appearance.

When to see a doctor

Dark under-eye circles usually aren’t a cause for concern. But you should see your doctor if you have any of these symptoms:

• Only one eye is constantly affected
• Changes in vision
• Eye pain
• Any other new symptoms that appeared around the same time as the dark circles

If your dark circles are a cosmetic issue and you want more advanced forms of treatments, see your dermatologist.

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