The appearance of small, raised lesions in the delicate skin surrounding the eyes (the periocular area) is a common experience. While these bumps can be a source of cosmetic concern, they are overwhelmingly benign and do not represent a health threat. These small growths are typically harmless skin conditions arising from different structures just beneath the surface. Understanding their distinct origins and appearances is the first step toward proper identification and management. This article breaks down the three most frequent causes of these bumps.
Keratin Deposits (Milia)
Milia are the most common cause of small, firm bumps under the eyes, frequently appearing as tiny white or yellowish cysts. These lesions form when keratin, a protein found in skin, hair, and nails, becomes trapped beneath the skin’s outer layer. The resulting structure is a small, dome-shaped pocket, typically one to two millimeters in diameter, often described as having a pearl-like look.
There are two main categories: primary and secondary. Primary milia develop spontaneously and are seen in up to half of all newborns, typically resolving without intervention within a few weeks. Secondary milia occur in adults as a result of skin trauma or damage. This damage can be caused by long-term sun exposure, blistering injuries, or the prolonged use of heavy topical creams that prevent the natural shedding of dead skin cells. Unlike acne, these bumps are non-inflamed and lack a pore opening, meaning they cannot be extracted by squeezing.
Sweat Gland Growths (Syringoma)
Syringomas commonly develop in the periocular region, often appearing in clusters on the lower eyelids. These growths originate from the ducts of the eccrine sweat glands, which produce sweat to cool the body. They present as small, slightly raised bumps that are flesh-colored, pink, or sometimes faintly yellowish.
These lesions tend to appear later in life, often during adolescence or early adulthood, and are more frequently observed in women. Unlike milia, syringomas are classified as benign tumors of the sweat ducts and persist indefinitely once they form. While the exact cause is not fully understood, genetic predisposition plays a significant role. Syringomas have also been linked to certain systemic conditions, including Down syndrome and diabetes mellitus.
Lipid Accumulations (Xanthelasma)
Xanthelasma presents as soft, flat, yellowish plaques that typically appear near the inner corner of the eyelids, often symmetrically. These accumulations are distinct because they are composed of deposits of cholesterol and other lipids under the skin. They are the most prevalent form of xanthoma localized to the eyelids.
The presence of xanthelasma often serves as an important visual indicator of a potential underlying health issue. Approximately half of the adults who develop these deposits have abnormal lipid levels in their blood, such as high LDL cholesterol or triglycerides. While the deposits themselves are harmless, they can signal a need to check for systemic conditions like hyperlipidemia, diabetes, or thyroid dysfunction. A medical evaluation is necessary when xanthelasma is identified.
Options for Removal and Medical Evaluation
Any new or persistent growth around the eye warrants a professional diagnosis from a dermatologist or ophthalmologist. For milia, self-extraction is strongly discouraged as it can lead to scarring, infection, and permanent skin damage. Professional treatments typically involve careful lancing and extraction, chemical peels, or targeted laser ablation to safely remove the keratinized material.
Managing syringomas and xanthelasma begins with a medical consultation to determine the appropriate course of action. If xanthelasma is suspected, a healthcare provider will order a blood panel to check lipid levels, as managing underlying high cholesterol is the priority before cosmetic removal. Both syringomas and xanthelasma can be treated with methods such as laser therapy, cryotherapy (freezing), or electrocautery, which uses heat to destroy the tissue. Recurrence is possible, especially if the underlying cause of xanthelasma is not addressed.