Milia Under the Eyes: What Those White Bumps Are and How to Remove Them

Milia under the eyes are tiny, firm, pearly-white bumps made of trapped keratin, the protein in the outer layer of skin. They aren't pimples and have no opening, so they can't be popped. Many clear on their own over weeks or months. If they don't, a dermatologist can remove them with a sterile needle or blade.

Below is what milia are, how they differ from whiteheads, what tends to cause them, the treatments that work, and why the needle-and-mirror method is a bad idea this close to your eye.

What are milia?

A milium is a tiny cyst filled with keratin. DermNet describes milia as tiny pearly-white bumps just under the surface of the skin and notes that these harmless cysts are usually multiple. They most often arise on the face and are particularly prominent on the eyelids and cheeks, which is why the under-eye area is where so many people first notice them. Cleveland Clinic lists the eyelid or under the eyes first among the most common places to find milia.

The bumps feel hard, like a grain of sand under the skin, and they don't hurt or turn red the way a pimple does. DermNet describes primary milia in children and adults, so they're not only a baby or a teenage thing.

What's the difference between milia and whiteheads?

A whitehead is a clogged pore, and a milium is a sealed cyst under the skin. The American Academy of Dermatology (AAD) explains that whiteheads form when pores become clogged with excess oil, bacteria and dead skin cells and the pore closes up. Milia contain keratin with no oil plug and no pore opening at the surface, which is why squeezing gets you nowhere.

If your bumps are on your forehead and chin and come and go in crops, read our guide to closed comedones on the forehead instead. If they're sore and red, our guide to getting rid of whiteheads covers acne treatment.

What causes milia under the eyes?

Often there's no clear cause. Many milia simply appear, and DermNet separates these from forms with known triggers. These are the causes it lists:

• Skin injury. Milia can occur at the site of injury as the skin heals, for example after burns or dermabrasion.
• Blistering skin conditions. They can follow blistering rashes as the skin repairs itself.
• Some topical medicines. Milia may rarely follow the use of topical medication such as hydroquinone, 5-fluorouracil cream or a corticosteroid.

One look-alike is worth knowing. DermNet notes that colloid milia, golden-colored bumps on the cheeks and temples associated with excessive exposure to sunlight, should be distinguished from true milia. Despite the name they are a different condition, so golden or yellowish bumps are a reason to see a dermatologist rather than treat them as ordinary milia.

Do rich eye creams cause milia?

They may raise the odds. The American Academy of Ophthalmology lists oil-based makeup or skin care products that clog the pores among the things that put you more at risk, alongside long-term steroid use and skin conditions such as rosacea. DermNet doesn't list heavy creams among its established causes, so a rich eye cream is a possible contributor that hasn't been proven. If milia showed up after you started a thick, occlusive eye cream, switching to a lighter formula for a couple of months is a low-risk experiment. Keep notes on when you changed products so you can see whether anything shifts.

Do milia go away on their own?

Often, yes, though it can take a while. DermNet says milia may clear in a few weeks or persist for months or longer, and that they do not need to be treated unless they are a cause for concern for the patient. If one or two milia under your eyes don't bother you, leaving them alone is a reasonable choice.

How do you get rid of milia under the eyes?

The fastest route is professional extraction, and the slower at-home route is a gentle retinoid used carefully. DermNet lists these options:

1. Extraction (de-roofing). A doctor opens the thin skin over the milium with a sterile needle or blade and presses or lifts the keratin out.
2. Topical retinoids. DermNet suggests these for widespread milia. Expect this to take months, if it works at all for your milia.
3. Destruction. Diathermy (electrodesiccation) with curettage, or cryotherapy, used by a clinician.
4. Peels, dermabrasion and laser. DermNet notes these have been reported to be effective when used for very extensive milia.

Using a retinoid near the eyes

Go slowly. DermNet warns that topical retinoids can be irritating if applied close to the eyes or lips, and that adapalene is the least irritating of the common retinoids and tretinoin the most. The AAD suggests starting with the least-intense retinoid formula you can find, every other night, using it at night because retinoids make skin more sun-sensitive, and wearing sunscreen by day. Keep it on the cheekbone and the orbital bone, well away from the lash line, and stop if your eyes sting or water. If you're new to retinoids, our retinol for beginners guide covers the basics.

The AAD is clear that retinoids should not be used during pregnancy, and DermNet notes that some topical retinoids are contraindicated in pregnancy. If you're pregnant or trying to conceive, ask your doctor or leave the milia alone until later.

Is milia extraction at home safe?

Not under the eyes. The American Academy of Ophthalmology says to never try to squeeze or pop milia, because they can't be removed that way and you may damage or scar your skin. The skin there is thin, the eye is right next to it, and one slip of a needle or lancet can cut the lid or the eye itself. DIY attempts also tend to dig too deep, leaving a scab, a mark or a scar that lasts longer than the milium would have. The AAD warns that squeezing blemishes at home can lead to permanent acne scars and infection from the bacteria on your hands, and points out that extraction done by a dermatologist with sterile instruments is the safe version.

A few other popular hacks are worth skipping too:

• Scrubs. Rubbing can't reach a sealed cyst and irritates thin under-eye skin.
• Strong acid peels at home near the eye. Acids can sting the eye and irritate the lids.
• Squeezing with fingers or tools. With no opening, pressure just bruises the area.

If you want milia gone, a short visit to a dermatologist is quicker, safer and usually leaves cleaner skin than anything done in a bathroom mirror.

Can you prevent milia under the eyes?

You can't prevent every milium, since many appear for no clear reason, but you can lower the odds of the kinds with known triggers, such as skin injury and certain topical medicines. A few steps help:

• Treat the under-eye area gently: pat products on, and skip rough washcloths and scrubs.
• Don't use steroid creams on your face unless a doctor has prescribed them, since corticosteroids are among the topical medicines DermNet lists.
• Let burns, scrapes and procedures heal fully before restarting strong actives.
• If milia keep returning in one spot, note which products you were using; a pattern is easier to spot over a few months than in a single week.

Daily sunscreen is still worth wearing around the eyes, especially if you use a retinoid there; our guide to how much sunscreen to use covers the face and eye area.

When should I see a doctor about bumps under my eyes?

See a dermatologist if you want milia removed, if bumps keep spreading, or if what you have doesn't look like the classic pearly-white dot. Yellowish flat patches, bumps that grow, bleed or change shape, and anything near the eye that affects your vision are worth a professional look. A doctor can also tell milia apart from look-alikes that need different care.

How can a selfie scan help you keep an eye on milia?

Milia change slowly, so a few photos over a couple of months tell you more than a daily check in the mirror. Pori is an iPhone app that takes a selfie and returns an overall skin score from 0 to 100 with categories including Pores & Texture, reading your face region by region with a 468-point face mesh. Its before/after comparison is a simple way to see whether milia are fading after you switched eye creams or started a retinoid, and its ingredient scanner (a Pro feature) flags ingredients as beneficial, use with caution or avoid for your skin type when you're choosing a new eye product.

A selfie can't tell a milium from a whitehead or another bump at that size, and it can't check moles or growths. An app is not a diagnosis; see a dermatologist for any bump that changes, bleeds or worries you.