February 27, 2013
By Robert H. Shmerling M.D.
Beth Israel Deaconess Medical Center
Last reviewed February 27, 2013
Perhaps you've been there before: You stare into the mirror after too little sleep and looking back at you are puffy eyes surrounded by dark circles. You could swear off late nights, promise to get more sleep or apply makeup to cover the dark circles. But as you're pondering your options, did you ever wonder where those dark circles and "bags" come from? Why do some people always have dark circles under the eyes while others can stay up all night without their eyes giving them away?
Back to top
Why Puffy Eyes and Dark Circles Develop
There are several reasons why dark, puffy eyelids develop.
- Aging – The skin around the eyes is normally thinner and looser than skin elsewhere on the body. As we age, it becomes even looser and thinner. This allows fluid to collect, causing a puffy appearance. Veins under the skin can create the dark appearance of the skin.
- Sleep position – Lying horizontal can encourage fluid to collect beneath the eyes. It also promotes dilation of the veins under the eyes, which darkens the appearance of the skin even more. These veins drain into the nose. Nasal congestion or seasonal allergies also cause the veins under the eyes to dilate. Dark circles are so common with allergies, they're sometimes called "allergic shiners."
- Fluid retention – Anything that causes fluid retention, such as pre-menstrual bloating, can increase puffiness around the eyes.
- A genetic (inherited) tendency to have "bags under the eyes"
- A medical problem – Puffy eyes may be the first sign of fluid retention due to a medical problem, such as kidney or liver disease. Puffy eyes can also be a side effect of medication you are taking. If you develop new, significant swelling around the eyes that does not improve, contact your doctor, especially if you notice fluid retention elsewhere in the body, such as the legs.
Back to top
What Can You Do About Them?
The usual recommendations for dark, puffy eyelids are to get plenty of sleep and treat any medical condition that might be contributing. For example, medications that control symptoms of sinus problems or allergies may reduce the puffy, dark appearance of the eyelids. Limiting salt intake might reduce fluid retention. I found no rigorous scientific studies to support (or refute) these recommendations, however, they make sense even if you're not bothered by puffy eyes and dark circles.
Do Cucumbers Really Work?
If you have dark circles under your eyes or if your eyes are puffy, does applying cucumber slices over your eyes help? Does the cucumber have to be cold? Would the application of anything cold and of the appropriate size to cover the eyelids have the same benefit, or is there something uniquely beneficial about the cucumber? If cucumbers are effective, how do they work?
I heard these questions debated in an elevator last week. No one knew the answers, so I offered to find out. It's tough to find reliable answers! My medical textbooks make no mention of the relative merits of cucumbers (or any other vegetable) for the appearance of one’s eyes. And I could find no scientific studies attempting to test the theory of "the cucumber effect." I did, however, come across reports of allergic reactions to "cucumber eye gel."
Because the application of cucumber slices to the eyes is unlikely to cause significant harm, I can only offer my usual advice for untested, unproven but seemingly safe remedies: If it works for you, stick with it.
Makeup and various creams and ointments (often containing a mixture of moisturizers and vitamins) may be somewhat helpful. Regular use of sunscreen is a good idea since the thin skin beneath the eyes is particularly vulnerable to the sun's rays. Bleaching procedures, laser treatments and cosmetic surgery may be effective for darkened or baggy skin under the eyes that does not improve with other measures.
Back to top
Why The Myth?
It's a widespread assumption that puffy eyes and dark circles under the eyes are evidence of sleep deprivation, fatigue or ill health. That's far from proven. In fact, considering how common allergies, colds and sinus congestion are (to name a few alternative causes), chances are good that tired-looking eyes aren't really due to lack of sleep.
But they may be due to how we sleep — horizontally. Fluid accumulates and veins dilate making the lower lids look quite dark and puffy. Add to that harsh bathroom lighting and lack of makeup, and one's eyes can look pretty miserable first thing in the morning! So, it's easy to see how people mistake the result of a cold or allergy attack for sleep deprivation when they see dark, puffy eyes.
Back to top
The Bottom Line
The next time someone tells you that you look tired when you aren't, let them know that there's little truth to the assumption that puffy eyes and dark circles are due to fatigue or sleep deprivation. And while cucumbers seem to be the symbol of being pampered at a spa, for my money, I think they work better in a salad.
Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.