Bags Under the Eyes—why do we get them?

My least favorite part of getting enough sleep is not being able to concentrate. But a close second are those puffy, dark circles that appear below my eyes after a night of not-enough sleep. In this article, my colleague Dr. Rob Shmerling explains why this unflattering phenomenon occurs—and why it affects some of us more than others.  

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.

Your genes. Some people inherit the 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.

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.

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.

The myth surrounding dark circles

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.

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

Skin Care
Time and sun are tough on your skin, and troublesome skin conditions can set in at any age. But skin treatments have changed dramatically in recent years. Skin Care and Repair, a special report from Harvard Medical School, explains the latest high-tech solutions and drug regimens available to control both cosmetic and medical skin problems—from age-related wrinkles to life-threatening cancers.

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