Dark circles under the eyes: causes, assessment and when to seek help

Patient information for the general public. Last updated 19 August 2026.

What are dark circles?

“Dark circles” describes how the skin below the eyes looks. It is not one particular disease. The area may appear dark because of skin pigment, visible blood vessels, a shadow from the shape of the eyelid and cheek, puffiness, or a mixture of these.

Dark circles are usually harmless and are often a normal variation. They do not need treatment unless they are bothersome or there are other symptoms.

The distinction matters because different causes respond to different approaches. A cream cannot change a hollow or remove a lower-eyelid bag. Colour alone is not a reliable guide: pigment and visible blood vessels can both look blue-grey, especially in different lighting and skin tones.

Why do they happen?

Skin pigment

Some people naturally have more pigment around their eyes. Pigment can also develop after eczema, allergy, irritation or frequent rubbing. Sun exposure can maintain or worsen it.

Blood vessels showing through

Lower-eyelid skin is very thin. Normal blood vessels and the muscle beneath it may show through as blue, violet or pink. Nasal allergy, swelling and rubbing can make this more noticeable.

Shadows and hollows

The groove between the lower eyelid and cheek is called the tear trough. A deep tear trough, lower-eyelid bags, loose skin or loss of cheek volume can cast a shadow. This often looks better in direct frontal light and worse under overhead lighting.

Puffiness

Fluid around the eyelids can create both a shadow and a congested colour. It may be worse in the morning or vary from day to day. Allergy, dermatitis, some medicines and previous cosmetic treatment around the eyes are possible contributors.

Poor sleep can temporarily make puffiness and the appearance of fatigue worse, but it is usually not the main cause of longstanding dark circles.

How are dark circles assessed?

A clinician may examine the area in different lighting and gently stretch or support the lower-eyelid skin. This helps separate pigment and visible vessels from a structural shadow. Dermoscopy, which is examination with a magnifying light, can provide more detail.

The assessment also looks for dermatitis, swelling, a tear trough, loose skin and lower-eyelid bags. Blood tests are not routinely needed for longstanding, symmetrical dark circles. They may be appropriate when other symptoms suggest anaemia, a nutritional deficiency, thyroid disease or another medical problem.

What can help?

There is no single best treatment. The sensible first step is to identify the main cause and decide whether treatment is wanted at all.

Measures that may help include:

• Treating eczema or allergy and avoiding rubbing
• Reviewing cosmetics, skin care, fragrances, nail products and eye drops if contact allergy is possible
• Using broad-spectrum sunscreen around the eyes as tolerated, together with sunglasses and a hat
• Using camouflage or colour-correcting makeup, which is immediate and generally low risk, although cosmetics can irritate sensitive eyelid skin
• Taking photographs in consistent lighting before judging whether anything has changed.

A fixed hollow, lower-eyelid bag or loose skin cannot be corrected by a cream. Clinician-directed creams or procedures may sometimes be considered for particular causes, but suitability, expected benefit, recovery and risks depend on the individual. Some procedures near the eye can cause serious complications and require careful assessment. Persistent swelling after a previous cosmetic treatment should be assessed before having further treatment.

Many heavily promoted treatments for dark circles have only limited supporting evidence. Complete clearance is uncommon. A realistic aim is improvement in the dominant cause without making another component worse.

What is unlikely to help?

• Generic “brightening” eye creams when the main problem is a shadow
• Drinking extra water for fixed pigment or anatomy
• Iron, vitamin B12 or other supplements unless a deficiency has been diagnosed
• Treatments without first determining whether the main issue is pigment, visible blood vessels, swelling or anatomy.

When should I seek medical care?

Arrange medical review if the darkening is new, persistent and affects only one side, resembles unexplained bruising, or occurs with ongoing swelling.

Seek urgent medical care if there is severe eye pain, a new bulging eye, new double vision, or any sudden change or loss of vision. These symptoms are not typical of ordinary dark circles.

Questions to ask before treatment

Ask what is causing the appearance, which component a proposed treatment targets, what degree of improvement is realistic, how long any effect may last, what recovery is involved, and what the important risks and alternatives are. No treatment is also a reasonable choice.

Selected references

• Michelle L, et al. Treatments of periorbital hyperpigmentation: a systematic review. Dermatologic Surgery. 2021;47(1):70-74. PubMed
• Pissaridou MK, Ghanem A, Lowe N. Periorbital discolouration diagnosis and treatment: evidence-based review. Journal of Cosmetic and Laser Therapy. 2020;22(6-8):217-225. PubMed
• Ranu H, et al. Periorbital hyperpigmentation in Asians: an epidemiologic study and a proposed classification. Dermatologic Surgery. 2011;37(9):1297-1303. PubMed