Yellow circles under the eyes: what is important to know

A yellow tint under the eyes is not a disease in itself, but an external symptom that can be caused by a variety of mechanisms. In one person, it's xanthelasma, or localized yellow plaques on the eyelids. In two, it's jaundice of the skin and sclera due to elevated bilirubin. In three, it's carotenemia, where the skin turns yellow due to excess carotenoids, but the sclera remains white. In four, it's not true yellowness at all, but a yellowish-brown tint due to shadowing, thin skin, blood vessels, or post-inflammatory changes.

In practical terms, the most important first question is whether only the skin of the eyelids and infraorbital area is turning yellow, or whether the whites of the eyes, mucous membranes, and skin elsewhere are also turning yellow. If the sclera turns yellow, this already indicates jaundice and requires testing for bilirubin metabolism, liver disease, bile duct disease, or hemolysis. MedlinePlus and the Cleveland Clinic emphasize that scleral yellowness is one of the key indicators of jaundice. [1]

If the whites of the eyes remain white, but the yellowish changes are localized in the skin, the range of causes is different. Then, xanthelasma, carotenemia, local dermatological causes, and cosmetic and anatomical features of the periorbital area come to the fore. This is the main clinical clue that helps distinguish between safe and potentially serious scenarios. [2]

Xanthelasmas are particularly significant because patients often describe them as "yellow circles" or "yellow spots at the inner corners of the eyes." In reality, they are soft yellow papules or plaques, most often near the inner corner of the upper and lower eyelids, usually painless and without itching. They are benign in nature, but can be associated with lipid metabolism disorders, diabetes, thyroid disease, and sometimes liver disease. [3]

Carotenemia has a different appearance. It's a yellowish-orange discoloration of the skin due to excess carotenoids, most often associated with high consumption of carrots, pumpkin, mango, sweet potatoes, and other similar foods. A key feature is that the sclera remain white, and the carotenemia itself is usually benign and reversible. DermNet and clinical reviews emphasize this particular symptom as the key to distinguishing carotenemia from jaundice. [4]

Finally, it's important to remember that patients often describe not a true yellow color, but rather yellowish-brown or yellow-gray shadows under the eyes. Such shadows can be related to age, photodamage, eyelid skin friction, allergies, atopic dermatitis, and mixed vascular-pigmented conditions. Therefore, the complaint of "yellow circles" requires first clarifying whether these are actually yellow plaques, a generalized yellowness of the skin, or simply a yellowish tint in the periorbital area.

Table 1. What is most often hidden behind the complaint of yellow circles under the eyes. The table is based on data on xanthelasma, jaundice, and carotenemia from clinical sources. [5]

Appearance	What does it mean more often?
Soft yellow plaques at the inner corners of the eyelids	Xanthelasma
Yellowness of the skin plus yellow sclera	Jaundice
Yellowish-orange skin with white sclera	Carotenemia
Yellowish-brown shadows without plaques and without yellow sclera	Cosmetic-dermatological or mixed option
Sudden asymmetrical yellow-blue discoloration after impact	Post-traumatic change, not ordinary circles

Main reasons

Xanthelasma of the eyelids

Xanthelasma is the most common localized cause of yellow lesions on the eyelids. StatPearls, the Cleveland Clinic, and the American Academy of Ophthalmology describe it as soft, semi-hard, or slightly chalky, yellow papules and plaques containing lipids, most often located at the inner corner of the eyelids. Clinically, patients often perceive them as "yellowish circles," although they are actually discrete, flat lesions. [6]

Xanthelasmas are usually painless, non-itchy, and non-inflamed. They grow slowly and are more often a cosmetic rather than a functional concern. An important practical point is that they are not a sign of acute liver disease or an emergency, nor are they simply a "skin quirk," as in some patients they are associated with lipid metabolism disorders. [7]

A link between xanthelasma and dyslipidemia does exist, but it's not absolute. StatPearls notes that most patients have underlying lipid abnormalities, so it's advisable to check their lipid profile, as well as liver function tests, thyroid function, and glucose levels. DermNet also emphasizes that xanthelasma is often found in individuals with normal lipids. [8]

Current data provide a more nuanced picture. New studies from the ophthalmology literature suggest that the association between xanthelasma and cardiovascular risk and dyslipidemia may be weaker than previously thought. However, this does not change the rule of thumb: the appearance of xanthelasma is a reasonable reason to at least once evaluate the lipid profile and metabolic risk factors, rather than dismissing it as a purely cosmetic detail. [9]

Age must also be taken into account. In young patients, especially if plaques appeared early, are growing rapidly, or are associated with a family history of dyslipidemia, the likelihood of a hereditary lipid metabolism disorder increases. In such a situation, metabolic assessment is especially important. [10]

Jaundice

Jaundice is no longer a localized eyelid problem, but a systemic syndrome associated with excess bilirubin. MedlinePlus and the Cleveland Clinic define it as a yellowing of the skin, sclera, and mucous membranes due to the accumulation of bilirubin in the body. If a yellow tint appears under the eyes along with yellow whites of the eyes, dark urine, light-colored stools, itchy skin, or weakness, jaundice should be considered first, not cosmetics. [11]

In an adult patient, jaundice always requires an investigation into its cause. MedlinePlus lists infections, drug-induced liver injury, genetic syndromes, bile duct obstruction, and increased red blood cell breakdown among the primary mechanisms. Therefore, localized observation of "just the skin around the eyes" is inappropriate: a full clinical assessment is required. [12]

A key sign that helps differentiate jaundice from carotenemia and localized xanthelasma is yellowing of the sclera. The Cleveland Clinic specifically explains that scleral icterus occurs when the liver is unable to remove bilirubin. If the whites of the eyes are white, the likelihood of true jaundice is significantly lower. [13]

Jaundice can develop rapidly or gradually. MedlinePlus notes that it can appear suddenly or worsen slowly, and may also be accompanied by dark urine, light-colored stools, itching, and discoloration of the mucous membranes. This helps clarify that this is not a superficial discoloration of the eyelid skin, but a systemic disorder. [14]

Jaundice is common in newborns and usually has its own age-related causes, but in children beyond the neonatal period and in adults, yellowing of the skin and sclera requires a more serious assessment. For an adult or child outside the neonatal period, yellowing of the whites of the eyes is a reason to seek immediate medical attention. [15]

Carotenemia

Carotenemia is a benign accumulation of carotenoids in the skin. DermNet and StatPearls describe it as a yellowish-orange discoloration of the skin due to elevated blood carotene levels, most often due to an excess of beta-carotene-rich foods. Classic examples include carrots, pumpkin, mango, sweet potatoes, and other bright orange plant foods. [16]

The main practical difference between carotenemia and jaundice is the white sclera. This is emphasized by both DermNet and clinical reviews: with carotenemia, the skin turns yellow, while the sclera remains normal. It is this characteristic that makes carotenemia relatively easy to recognize if it is considered in the differential diagnosis. [17]

Carotenemia is usually more noticeable not so much under the eyes as on the palms, soles, nasolabial folds, and denser areas of the skin. Therefore, if a patient describes only localized "yellow circles" and no other yellowness, and the sclera are white, carotenemia is possible, but not always the most likely explanation. More often, it causes a more generalized change in skin tone. [18]

Although diet is often the underlying cause, there are also secondary causes. StatPearls and clinical reports indicate a link between carotenemia and hypothyroidism, diabetes, nutritional deficiencies, and certain metabolic disorders. Therefore, if the condition is atypical or lacks a clear dietary factor, the physician also evaluates underlying medical conditions. [19]

The good news is that carotenemia itself is safe and reversible. By reducing carotenoid intake and, if necessary, correcting the underlying condition, skin color gradually normalizes. This is what distinguishes it from jaundice, which is not considered a harmless condition in adults. [20]

Yellowish-brown shadows and local skin causes

Not all "yellowing" under the eyes is truly yellow. The original page correctly notes that patients often describe yellowish-brown or yellowish-gray shadows in the periorbital area as "yellow." Such changes are more often associated with post-inflammatory hyperpigmentation, vascular pigmented shadows, atopic or contact dermatitis, and age-related skin changes.

Contact irritation of the eyelids and chronic skin friction can change the color of the periorbital area after inflammation. In such cases, the hue is often described as yellow-brown or "dirty" rather than bright yellow. This is especially likely in those with itching, dryness, flaking, seasonal allergies, and a habit of rubbing the eyes.

Allergic rhinitis and nasal congestion can also intensify not only bluish-purple but also yellowish-gray shadows due to swelling, friction, and a mixed vascular-pigmentary mechanism. This is not xanthelasma or jaundice, but a more complex cosmetic and dermatological phenotype of the periorbital area.

Age-related thinning of the skin and anatomical shadows also alter color perception under the eyes. Depending on the lighting and the combination of vessels, shadows, and thin skin, the patient may describe the under-eye area as yellow, even though objectively there is no bilirubin or lipid plaque. Therefore, it is important for the doctor to examine not only the color but also the texture, symmetry, and presence of plaques.

The practical conclusion here is this: if the yellow tint under the eyes appears as a diffuse shadow without distinct plaques, without yellow sclera, and without general yellowing of the skin, then localized cutaneous and anatomical causes are often more likely than jaundice. However, this conclusion is made only after an in-person assessment of the nature of the lesion.

Table 2. How to roughly differentiate the main causes of a yellow tint under the eyes. Based on clinical signs of xanthelasma, jaundice, carotenemia, and local skin variants.

Cause	What does the diagnosis usually suggest?
Xanthelasma	Flat, soft, yellow plaques, often at the inner corners of the eyelids
Jaundice	Yellow sclera, dark urine, light-colored stool, itchy skin
Carotenemia	White sclera, yellowish-orange skin, food factor
Post-inflammatory skin changes	Itching, eyelid rubbing, dryness, dermatitis
Mixed vascular-shadow periorbital zone	Fuzzy yellowish-gray tint without plaques

When it can be dangerous

The most important and dangerous dilemma is whether the whites of the eyes are turning yellow. If the whites of the eyes turn yellow, you shouldn't delay seeing a doctor, as this is no longer a localized cosmetic problem, but potential jaundice. MedlinePlus and the Cleveland Clinic emphasize that yellowing of the sclera and skin in adults is a sign of hyperbilirubinemia, the causes of which can be serious. [21]

One should also be wary when "yellow circles" appear quickly and are accompanied by a general deterioration in well-being. Dark urine, light-colored stools, itchy skin, weakness, nausea, and pain in the right hypochondrium are more consistent with bilirubin syndrome than with harmless periorbital changes. In such a situation, even if the patient initially notices the tint under the eyes, the diagnostic evaluation should be systematic. [22]

Xanthelasma is usually not a cause for concern, but there is another concern: it's a reason to consider your lipid profile and associated metabolic factors. Although newer studies are more cautious about assessing the association of xanthelasma with cardiovascular risk, the clinical recommendation to at least once check lipids, glucose, and thyroid function remains reasonable. [23]

If the yellowish tint is localized but the lesion is unilateral, rapidly growing, painful, itchy, oozing, or associated with significant swelling, it is less consistent with xanthelasma or carotenemia and requires dermatological or ophthalmological evaluation. This pattern may indicate localized inflammation, contact dermatitis, traumatic change, or another condition not described here. [24]

Newborns deserve special attention. Jaundice in them may be frequent and normal, but it still requires age-appropriate monitoring. If the issue concerns an adult or a child beyond the neonatal period, yellow sclera and yellow skin can no longer be considered harmless. [25]

Table 3. Red flags for yellow under-eye circles. Based on jaundice symptoms and the clinical significance of xanthelasma. [26]

Sign	Why is this important?
Yellow sclera	The main argument in favor of jaundice
Dark urine and light-colored stool	Suspected bilirubin syndrome
General weakness, itching, nausea	Liver and biliary tract evaluation required
Rapid yellowing	Atypical for quiescent xanthelasma
Localized yellow plaques on the eyelids	Not urgent, but metabolic screening is needed
Asymmetrical inflammatory change in the skin of the eyelid	Local pathology must be excluded.

How does a doctor figure out the cause?

Diagnosis begins with a simple but crucial visual distinction: are there yellow plaques, a generalized yellowness of the skin, or just a localized tint under the eyes? Xanthelasma appears as localized yellow papules or plaques. Jaundice causes a more generalized yellowing of the skin and sclera. Carotenemia discolors the skin but not the sclera. Even at this stage, it often becomes clear which direction to take next. [27]

The next step is asking about accompanying symptoms. If jaundice is suspected, the doctor will inquire about the presence of dark urine, light-colored stool, itching, abdominal pain, medications, alcohol, viral risk factors, and weight loss. If carotenemia is suspected, the doctor will inquire about the patient's diet, supplements, and possible metabolic diseases. If xanthelasma is suspected, a family history of dyslipidemia, diabetes, and thyroid disease will be inquired about. [28]

With xanthelasma, the diagnosis is usually clinical, based on appearance. However, StatPearls recommends laboratory evaluation: a lipid profile, and, if indicated, a liver panel, thyroid function, glucose, and, if necessary, a glycated hemoglobin level. This is done not to confirm the plaque itself, but to look for underlying disorders. [29]

If jaundice is suspected, the diagnosis is entirely different. MedlinePlus and the Cleveland Clinic indicate that it revolves around assessing bilirubin, liver function tests, causes of hemolysis, and possible biliary obstruction. Depending on the situation, the doctor will prescribe blood tests and instrumental procedures, if indicated. [30]

Carotenemia is more often diagnosed clinically, especially if the patient has a typical diet and white sclera. However, if in doubt, the doctor also considers secondary causes, such as hypothyroidism and diabetes, as they can affect carotene metabolism. Therefore, a benign condition does not always mean that a search for causes is unnecessary. [31]

Table 4. What is usually assessed during a consultation. The basis is clinical signs of jaundice, xanthelasma, and carotenemia. [32]

What is being assessed?	Why is this necessary?
Are there yellow sclera?	Separate jaundice and cutaneous variants
Are there plaques on the eyelids?	Suspicion of xanthelasma
Skin tone in other places	Assess the systematicity of the process
Diet and supplements	Search for carotenemia
Lipid profile, glucose, thyroid gland	Search for underlying causes of xanthelasma
Bilirubin and liver function tests	Finding the cause of jaundice

Treatment

Treatment depends solely on the cause. It's impossible to "treat yellow circles" as a single condition, as xanthelasma, jaundice, carotenemia, and post-inflammatory yellowish shadows require completely different approaches. Therefore, the first task is to correctly identify the mechanism of the color change. [33]

Xanthelasma is treated primarily for cosmetic reasons. The Cleveland Clinic and the American Academy of Ophthalmology indicate that removal options include surgical excision, chemical treatments, cold, heat, and other topical methods. However, it's important to understand that lowering cholesterol alone doesn't always clear existing plaques, although it is important for overall metabolic health. [34]

Jaundice is treated not by skin color, but by the underlying cause of hyperbilirubinemia. This may involve treating liver disease, eliminating bile duct obstruction, correcting hemolysis, or discontinuing the offending medication. Expecting jaundice to "go away on its own" without understanding the cause is unsafe in an adult patient. [35]

Carotenemia is much easier to treat. Typically, it's enough to reduce dietary carotenoid intake and, if necessary, correct the underlying metabolic disorder. The condition is benign and gradually reversible, but skin discoloration may not resolve immediately, but may take weeks or months. [36]

If a yellowish tint under the eyes is due to local inflammatory or pigmentary causes, the treatment depends on the underlying cause. For dermatitis, the underlying dermatitis is treated and the triggers are eliminated. For allergic rhinitis, the allergy is controlled and eyelid skin friction is reduced. For age-related and anatomical shadows, cosmetics have limited effectiveness, and procedures are sometimes discussed, but this is a separate cosmetic approach, not a treatment for true yellowness.

Table 5. What helps with different causes. Based on modern sources on xanthelasma, jaundice, and carotenemia. [37]

Cause	The basic approach
Xanthelasma	Metabolic screening and removal for cosmetic reasons
Jaundice	Treatment of the cause of hyperbilirubinemia
Carotenemia	Correction of diet and background metabolic disorders
Allergic and inflammatory local changes	Control inflammation, avoid friction, treat the underlying process
Age and shadow variants	Cosmetic correction according to indications

Prevention and prognosis

The prognosis depends on the cause. Xanthelasma itself is benign, but may recur after removal. Carotenemia is safe and reversible. Jaundice is not assessed on a "will it go away" basis, because its prognosis is determined by the underlying disease, not the skin color itself. [38]

Strictly speaking, preventing xanthelasma is not always possible, as some cases are related to heredity and local factors. However, controlling lipids, blood sugar, body weight, smoking, and overall cardiovascular risk remains a reasonable strategy, especially if xanthelasma has already developed. [39]

Carotenemia prevention is simpler: avoid overindulging in foods and supplements high in carotenoids and consider underlying metabolic conditions. It is not dangerous, but it can create diagnostic confusion if the sclera and diet are not assessed. [40]

If the yellowish tint under the eyes is due to allergies and skin rubbing, prevention focuses on controlling the allergy and avoiding eye rubbing. This helps reduce both local inflammation and discoloration of the skin around the eyes.

The main practical conclusion is this: yellow circles under the eyes cannot be automatically attributed to either the liver or cosmetics. The most useful algorithm is to first look at the sclera, then determine whether there are localized plaques, then assess the overall condition, and only then decide on treatment or examination. [41]

Table 6. When to observe more often and when to see a doctor. Based on signs of jaundice and xanthelasma from clinical sources. [42]

Situation	Tactics
Localized yellow plaques without pain and without yellow sclera	Routine assessment and metabolic screening
White sclera, food factor, yellowish-orange skin	Consider carotenemia
The sclera turns yellow	Urgent medical assessment
Yellow tint plus dark urine and light stool	Urgent assessment of the cause of jaundice
Rapid asymmetrical change of the eyelid skin	In-person assessment of the local cause

FAQ

1. Are yellow circles under the eyes always the liver?
No. Xanthelasma is a very common local cause, and carotenemia and yellowish-brown local skin changes are also possible. But if the sclera turns yellow, then bilirubin and the liver should be the first concerns. [43]

2. How can you distinguish xanthelasma from jaundice?
With xanthelasma, individual soft yellow plaques are usually visible on the eyelids, most often at the inner corners of the eyes. With jaundice, not only the eyelids turn yellow, but also the whites of the eyes and skin in other areas, and urine and stool often change. [44]

3. What is most suggestive of carotenemia?
White sclerae, a yellowish-orange tint to the skin, and a dietary history of excess carotenoids. For carotenemia, it is especially important that the sclerae remain normal. [45]

4. Does xanthelasma always indicate high cholesterol?
No, not always. Some patients have normal lipids, and newer studies are less rigorous in assessing the link with dyslipidemia than they once were. However, a lipid profile is still usually recommended. [46]

5. Is xanthelasma removal urgent?
Usually not. It's benign and is usually treated electively if the appearance is a concern or metabolic status needs to be clarified. The urgency arises not because of the xanthelasma itself, but because of possible associated risk factors. [47]

6. How do you know if it's jaundice, not just a yellowish tint to the skin?
The main clue is a yellowing of the sclera. Dark urine, light-colored stools, itchy skin, and weakness may also appear. [48]

7. Is carotenemia dangerous?
Usually not. It is considered a benign and reversible condition, although if it occurs atypically, underlying metabolic causes should be considered. [49]

8. Why do some people call regular under-eye shadows yellow?
Because periorbital shadows can have a yellowish-gray or yellowish-brown tint due to a combination of thin skin, blood vessels, pigment, dermatitis, and lighting. This isn't always a true yellow coloration of the tissue.

9. What should I do at home before my doctor's appointment?
If the sclera is white and carotenemia or a localized cutaneous variant is more suspected, it's helpful to evaluate diet, new skin products, and the presence of localized plaques. However, if the sclera is yellow or there are general symptoms, a visit should not be delayed. [50]

10. What tests are most often needed?
In xanthelasma, lipid profile, glucose, and thyroid function are most often assessed. In jaundice, bilirubin, liver function tests, and a search for the cause of hyperbilirubinemia are performed. In carotenemia, a clinical assessment is often sufficient if the picture is typical. [51]