A small, white, non-painful bump appearing on the delicate skin beneath the eye is a common concern that prompts many people to seek answers. The appearance of such a bump can be unsettling, especially in a prominent area of the face, but the vast majority of causes are benign. Understanding the likely origins of these skin changes is the first step in addressing them. For any persistent, changing, or irritating lesion, seeking an evaluation from a medical professional, such as a dermatologist or ophthalmologist, is always the recommended course of action.
Milia The Most Frequent Cause
The most frequent answer to the appearance of a small white bump under the eye is milia, which are tiny, harmless cysts formed by trapped keratin beneath the skin’s surface. Keratin is a durable protein naturally found in skin tissues, hair, and nails. When it becomes entrapped rather than shedding, it creates a small, hard inclusion cyst. Milia typically appear as small, dome-shaped papules, measuring one to two millimeters in diameter, and are characteristically pearly white or yellowish-white in color.
These bumps are firm to the touch and, unlike acne lesions or whiteheads, are not red or inflamed. They cannot be easily squeezed or popped because they lack a true pore opening. Milia are categorized based on their origin. Primary milia arise spontaneously and are common in newborns, but they can also occur in adults without an apparent cause.
Secondary milia develop following trauma or damage to the skin, such as blistering injuries, burns, or aggressive skin treatments like dermabrasion or laser resurfacing. Chronic sun damage and the long-term use of heavy, occlusive topical creams can also contribute to the formation of secondary milia by hindering the skin’s natural exfoliation process.
Other Conditions That Appear as White Bumps
While milia are the most common cause, several other conditions can present as small, white, or yellowish lesions under the eye, each with distinct characteristics.
Syringomas
Syringomas are benign growths that originate from the ducts of the eccrine sweat glands. They can be easily mistaken for milia due to their location. They often appear as small, yellowish or skin-colored bumps, usually in clusters, and are generally deeper in the skin than milia, making them more challenging to treat. Syringomas are frequently found on the lower eyelids and can sometimes be genetic, recurring even after professional removal.
Xanthelasma
Another distinct possibility is Xanthelasma, which involves the deposition of cholesterol within the skin, typically appearing as soft, flat, yellowish plaques. Unlike the small, hard, dome-shaped milia, xanthelasma lesions are larger, flatter, and have a more distinct yellow hue. They commonly cluster near the inner corners of the eyelids. The presence of xanthelasma is sometimes associated with underlying elevated cholesterol levels or other lipid disorders.
Sebaceous Hyperplasia
Sebaceous hyperplasia is a third condition to consider, caused by enlarged sebaceous (oil) glands. These lesions usually appear as yellowish-white papules with a notable central indentation or dimple, which distinguishes them visually from the smooth, dome-shaped milia. They are most often seen in middle-aged or older adults. They result from the overgrowth of oil-producing cells, causing sebum to become trapped.
Safe Removal and Professional Consultation
Given the sensitive nature of the skin surrounding the eye and the potential for misdiagnosis, attempting to remove any bump yourself is strongly advised against. Squeezing, picking, or using unsterilized tools can introduce bacteria, leading to infection, inflammation, and potentially permanent scarring in the delicate periorbital area. Professional extraction is the safest and most effective method for removal, particularly for milia and other benign lesions.
A dermatologist or ophthalmologist can perform a simple procedure called “deroofing” or manual extraction. A sterile blade or needle is used to create a tiny opening, allowing the keratin plug to be gently removed with a comedone extractor. Other professional options include cryotherapy, which uses liquid nitrogen to freeze and destroy the bump, or laser ablation, which focuses a small laser to vaporize the lesion.
For conditions like syringomas and sebaceous hyperplasia, more advanced techniques such as laser resurfacing, electrocautery, or chemical peels may be necessary, as these lesions often lie deeper within the skin. Consulting a medical specialist is particularly important if the bump is painful, red, inflamed, rapidly growing, bleeding, or if it begins to affect your vision. Topical retinoids can sometimes be recommended by a doctor for long-term prevention, as they help regulate skin cell turnover.