Small bumps beneath the eyes are a common concern. While cosmetically frustrating, these growths are usually medically harmless. They represent several distinct skin conditions. Understanding the specific characteristics of these bumps is the first step toward determining appropriate care. This information identifies what these bumps are, why they form, and the safest methods for managing or removing them.
Understanding the Most Common Types
The majority of small bumps under the eyes fall into three primary categories, each with a unique appearance. Milia are perhaps the most recognized, presenting as tiny, firm, white or yellowish dome-shaped cysts, typically measuring only one to two millimeters across. These bumps are filled with a hardened protein and feel like a grain of sand just beneath the skin’s surface. They often appear in clusters but are neither painful nor itchy.
Syringomas appear as small, flesh-colored, yellowish, or slightly brownish papules, which are often soft and symmetric. They tend to cluster on the lower eyelids and upper cheeks, sometimes creating a cobblestone-like texture on the skin. Unlike milia, syringomas are benign tumors arising from sweat ducts.
The third common type, Xanthelasma, is visually distinct, presenting as soft, flat, or slightly raised yellowish plaques. These deposits usually develop near the inner corner of the upper and lower eyelids and are often symmetrical, appearing on both sides of the face. Their yellowish hue is a defining characteristic that sets them apart from the other two conditions.
Causes Behind Their Formation
Milia form when keratin, a protein found in skin, hair, and nails, becomes trapped beneath the outer layer of skin. This trapping occurs because dead skin cells fail to shed naturally, leading to the formation of a tiny cyst rather than a pimple. This condition is sometimes associated with sluggish skin cell turnover, often exacerbated by sun damage or the long-term use of heavy, occlusive skincare products that prevent proper exfoliation.
Syringomas develop from an overgrowth of cells originating in the eccrine sweat ducts, which produce sweat. While the exact trigger is not fully understood, these growths are considered benign tumors of the sweat gland and often have a strong genetic component. They are not directly related to clogged pores or sun exposure, but they may be observed more frequently in individuals with certain genetic syndromes or diabetes.
Xanthelasma has a clear link to lipid metabolism, resulting from the accumulation of cholesterol and other fatty deposits within specialized immune cells called macrophages in the skin. These cholesterol-laden cells aggregate to form the characteristic yellow plaques. Its presence is a visible indicator of an internal imbalance in the body’s processing of fats.
Safe Management and Removal Options
It is important to resist the impulse to attempt self-extraction for any of these bumps, especially around the delicate eye area. Trying to squeeze or pick at milia can lead to skin trauma, infection, or permanent scarring, as these lesions do not have an open pore like a typical acne breakout. Instead, at-home management for milia can include gentle exfoliation using mild chemical exfoliants like alpha hydroxy acids (AHAs) or topical retinoids, which encourage faster skin cell turnover.
Professional treatment is often necessary for persistent or widespread lesions, particularly for syringomas and Xanthelasma. A dermatologist can safely perform manual extraction for milia using a sterile instrument to create a tiny opening and remove the keratin plug. For all three conditions, professional removal methods include ablative treatments such as carbon dioxide (CO2) or Erbium Yag laser therapy, which vaporize the tissue with precision.
Other effective in-office procedures are available. Xanthelasma may also be treated with trichloroacetic acid (TCA) chemical peels or surgical excision for larger plaques. These professional methods minimize the risk of scarring and are carried out with careful consideration for the proximity to the eye.
Additional Removal Techniques
- Cryotherapy, which uses extreme cold to freeze the growth.
- Electrodessication, which uses an electric current to destroy the tissue.
When Bumps Signal a Systemic Health Issue
While milia and most localized syringomas are strictly cosmetic concerns, the appearance of Xanthelasma warrants immediate medical evaluation because it can signal systemic health problems. The yellow plaques of Xanthelasma are strongly associated with underlying hyperlipidemia, which is an abnormally high concentration of fats, such as cholesterol, in the blood. Studies suggest that up to half of the people who develop Xanthelasma have elevated cholesterol levels.
The presence of Xanthelasma may indicate an increased long-term risk for cardiovascular disease, including heart attack and stroke. It is considered a biomarker suggesting cholesterol deposits may also be building up in the blood vessels. Therefore, any person presenting with Xanthelasma should have a full lipid panel blood test and be screened for related conditions, such as diabetes and thyroid dysfunction. Additionally, any under-eye bump that is rapidly changing, painful, bleeding, or inflamed should be examined by a healthcare provider to rule out more serious skin conditions.