By Gary M. White, MD
There are many causes of "bags under the eyes" or a darker coloration of the skin. Eczema is common, causing a darkening of the skin due to post-inflammatory hyperpigmentation. Sometimes the color is a result of thinner skin and more prominent underlying vasculature as shown here.
Dacryocystocele. Bluish cystic lesion, seen in the first week of life, just inferior to the medial canthus.
Basal Cell Carcinoma (may look cystic).
Some cases of chronic periorbital swelling may represent primary lymphedema which may have its onset late in life (lymphedema tarda). Secondary lymphedema from other causes should be considered, e.g., rosacea, allergic contact dermatitis, XRT for brain cancer (pictured below), anaphylactic reactions, active temporal arteritis, various localized inflammatory processes (e.g. cellulitis, abscess, trauma, orbital pseudotumor), superior vena cava syndrome and hypoalbuminemia. Lymphatic dysfunction causing periorbital edema has been reported to occur in Noonan's syndrome. Angiosarcoma has been reported to occur in chronic eyelid swelling.
Rosacea, so called Morbihan Disease
Lymphoma: Rarely, chronic facial edema may be due to an underlying lymphoma J Clin Oncol. 2012 Sep 1;30(25):e233-6
Cutaneous Lupus Erythematosus Periorbital mucinosis. Periorbital swelling may occur secondary to dermal mucin deposition in lupus erythematosus For a picture, see JAAD April 2010 Volume 62, Issue 4, Pages 667–671
See Eczema in "Red, Scaly" below.
Orange Palpebral Spots [Acta Derm Venereol 2011; 91: 211–212].
Basal Cell Carcinoma
Lupus Miliaris Disseminatus Faciei
Primary Systemic Amyloidosis
Molluscum of the eyelid. For a picture, see JAAD May 2014 Volume 70, Issue 5, Pages 795.e1–795.e25
See here for a general discussion of periorbital pigmentation and Familial Periorbital Melanosis
Nevus Of Ota
Benign nevus of eyelid margin (biopsied).
Raccoon eyes. Raccoon eyes may be bilateral or unilateral. If bilateral, it is highly suggestive of basilar skull fracture, with a positive predictive value of 85%. Most often associated with fractures of the anterior cranial fossa. Raccoon eyes may also be a sign of disseminated neuroblastoma (for a picture, see Indian J Dermatol Venereol Leprol 2012;78:740-1) or of amyloidosis. Raccoon eyes always require urgent consultation and management.
Primary Systemic Amyloidosis
Breast Carcinoma [JAAD 1997;37;362].
Lichen Planus. Red, violaceous papules and slightly scaly annular plaques on the eyelids is characteristic of this unusual localization of lichen planus. Typical lesions may occur elsewhere. Referral to an ophthalmologist to exclude ocular lichen planus (e.g., blepharitis, conjunctivitis) has been recommended.
The skin around the eyes is very sensitive. It may become inflamed from dry air, exfoliants and other face creams, or from airborne allergens e.g., pollens. See eyelid dermatitis.
A child with atopic dermatitis.
Allergic Contact Dermatitis, here to nail polish. Courtesy Michael O. Murphy, MD
Atopic Dermatitis (Dennie-Morgan folds).
Periorbital Rhytides (Wrinkling)
Normolipemic Plane Xanthomas
Yellow Skin Under the Eyes
Adult orbital xanthogranulomatous diseases are collectively considered within the broader group of non-Langerhans histiocytic disorders. Clinical, laboratory and histologic features help make the diagnosis.
|Adult-onset Orbital Xanthogranuloma||Absence of features below|
|Necrobitoic Xanthogranuloma||Paraproteinemia and multiple myeloma|
|Erdheim-Chester disease||Frequent impairment of visual acuity and fibrotic involvement of internal organs|
|Adult-onset asthma with periocular xanthogranuloma||Adult-onset asthma and elevated levels of polyclonal IgG|
Necrobiotic Xanthogranuloma Courtesy Theodore Sebastian, MD
Adult-onset Orbital Xanthogranuloma
Homepage | FAQs | Use of Images | Contact Dr. White