Periorbital hyper pigmentation (#Dark_cirkles) is caused by various exogenous and endogenous factors.
Recently, Huang et al6 performed a clinical analysis and proposed classification on the basis of clinical pattern of pigmentation and vasculature.
Periorbital hyperpigmentation was classified into
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pigmented (brown color),
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vascular (blue/pink/purple color),
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structural (skin color), and
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mixed type based on the clinical appearance assessed by the physician.
The mixed type of dark eye circle included the following four subtypes: as
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pigmented-vascular (PV),
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pigmented-structural (PS),
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vascular-structural (VS), and
a combination of the three.
Pigmented type § appears as infraorbital brown hue.
Vascular (V) type appears as infraorbital blue, pink, or purple hue with or without periorbital puffiness.
Structural type (S) appears as structural shadows formed by facial anatomic surface contours. It can be associated with infraorbital palpebral bags, blepharoptosis, and loss of fat with bony prominence.
Mixed type (M) combines two or three of the above appearances. This classification can help in introducing the therapeutic modalities on the basis of POH type, as different types of POH respond to different types of treatment.
Clinically, POH is characterized by light- to dark-colored, brownish-black pigmentation surrounding the eyelids. It gives a tired look to the patient. Diagnosis is mainly based on clinical examination. It is important to differentiate the dark eyelid skin with shadowing due to tear trough. Manual stretching of the lower eyelid skin can help to differentiate between true pigmentation and shadowing effect. Although the former retains its appearance with stretching, the latter improves or resolves entirely. An increase in violaceous discoloration on manual stretching of the lower eyelids is due to thin eyelid skin or hypervascularity of lower eyelid.
Wood’s lamp examination can be done to differentiate between the epidermal and dermal pigmentation.8 The variations in epidermal pigmentation become more apparent under Wood’s light. For dermal pigmentation, this contrast is less pronounced. Ultrasonographic evaluation can help to differentiate the vascular cause from the periorbital puffiness.