Dark under eyes/tired looking eyes – can they be cured?

Tired looking eyes can be difficult to treat because there can be so many factors responsible for the tired look. A skilled doctor will be able to recognise the cause and determine the most appropriate treatment. In this article we will summarise the causes of tired looking eyes and how we can treat them.

The causes of dark eyes include excessive pigmentation (brownish discolouration), visible blood vessels (blue discolouration), structural changes (dark shadows), or combinations of these.

Excessive pigmentation:

Dark eyes from excessive pigmentation leads to a typically brownish change in colour. This can be due to genetics, inflammation, hormones or excessive eye rubbing.

Treatment of dark eyes from excess pigment may involve:

• Skin lightening creams – hydroquinone is the most effective of these but should be prescribed in consultation with a doctor. Other creams which may reduce pigmentation include kojic acid, azelaic acid, vitamin C creams
• Chemical peels – lactic acid peels and TCA peels have shown good effect. Peels can be combined with micro-needling to increase penetration of the peel. These work by sloughing off the old pigmented skin and allowing fresh skin underneath to show. Pretreatment with hydroquinone and tretinoin may enhance the effect of the peel.
• Retinoic acid – increases skin turnover so sloughs off the pigmented skin allowing fresh skin underneath to show
• Sunscreen – protects the skin from pigmentation changes due to sun exposure. Reduces the chance of post-inflammatory hyperpigmentation. A physical sunscreen is preferred over a chemical sunscreen in the delicate eye area.
• Lasers – Q-switched Nd:Yag lasers can be used to remove the skin pigmentation
• Makeup – makeup can be used to cover the brownish discolouration

Visible blood vessels:

This type of dark eye has a bluish discolouration. As people grow older, the skin gets thinner and collagen fibers are lost. This may reveal tiny blood vessels beneath the skin. A good test to find out if superficial blood vessels are causing dark eyes is to stretch the skin underneath the eye between to fingers and to see if the area darkens. If so, you may have thin skin and superficial blood vessels.

Treatment:

• Fat transplantation or fillers: Both fat transplantation and fillers aim to decrease the dark eyes by increasing the distance between the blood vessels and the surface layer of the skin.
• Makeup: makeup can be used to cover up the bluish discolouration

Structural dark eyes:

Tear trough defect:

• Dark eyes may be due to shadows cast by a lack of volume in the area. This may accentuate the palpebromalar groove or tear trough deformity. Like visible blood vessels, this is best treated with fat transplantation or fillers.

Other causes of tired eyes:

Wrinkles: crows feet can be adequately treated with anti-wrinkle injections. Other alternatives include chemical peels or ablative lasers to remove old skin and allow fresh skin to replace it. Pelleve skin tightening can also regenerate collagen to reduce to appearance of wrinkles.

Eye bags: certain eye bag deformities can be treated with fillers or fat transfers to even out the prolapsed fat in mild cases. Typically, surgery in the form of lower eyelid blepharoplasties is needed for moderate severe cases.

Saggy upper eyelid: required surgery in the form of upper eyelid blepharoplasty

Milia: tiny raised dots forming around the eye; these are composed of trapped keratin underneath the skin. They can be prevented with proper cleansing, chemical exfoliation and retinols.