Dark Circles and the Liver: Causes, Signs and Medical Diagnosis

When the body breaks down old red blood cells, it produces bilirubin. The liver is responsible for clearing most of it. If this pigment builds up, the whites of the eyes, the skin and the mucous membranes can turn yellow: this is jaundice, also called icterus. This yellow tint is different from the dark discolouration or the shadow of a dark circle.

Some liver diseases also change the colour of the skin. In primary biliary cholangitis, the skin can darken as the disease worsens. In hemochromatosis, in which iron builds up in the body, the skin can take on a grey, metallic or bronze tint. A colour under the eyes is not enough to identify these diseases.

Porphyria cutanea tarda shows up differently. This disease involves increased porphyrins in the blood and urine; these substances cause fragility and blisters on skin exposed to the sun. The backs of the hands and the arms can be affected. These skin manifestations are not dark circles.

If you notice a change in addition to your dark circles, describe it to your doctor:

Several mechanisms can occur together under your eyes. These are called mixed dark circles.

Sleeping more does not necessarily remove pigment or the shadow of a hollow. You can therefore still have dark circles even though you sleep well, or have very pronounced dark circles because several mechanisms overlap: hereditary pigmentation, thin skin and a hollow that deepens with age.

Sleep alone does not tell you how pronounced your dark circles will be. Melanin contributes to their colour, but this finding does not mean that a lack of sleep never plays a role. Sleeping well does not guarantee that they will become lighter, any more than a dark circle is a measure of how well you sleep.

Rubbing or scratching your eyes can leave more pigment. Eczema or a contact allergy can also keep inflammation going. If your skin itches or stays irritated, having this irritation examined helps in understanding what accompanies the dark circles.

Prolonged sun exposure, stress, long hours in front of the television and taking a hormonal pill have been associated with dark circles. An association does not mean that each of these factors causes them, or that removing these factors will make the dark circles disappear.

Prevention is therefore about more than changing a habit. Avoiding rubbing irritated skin addresses the rubbing mechanism; it does not correct a hollow or hereditary pigmentation. Alcohol, smoking, hydration and your cosmetic routine must not be presented as established ways to change your dark circles.

A bag can come from changes in contour under the eye, in particular from fat that pushes forward with age, while swelling can be due to fluid. The fact that a bag is there every day, or that you notice no other sign, is not enough to decide that it is purely cosmetic.

If you are unsure whether it is a bag or swelling, ask for its cause to be clarified before choosing a treatment. Treatment for under-eye bags then depends on what causes them. Some kidney diseases can cause swelling around the eyes; swelling in the legs or abdomen prompts a search for other causes, including some liver or heart diseases. A bag when you wake up does not tell you how healthy your liver is.

Among the causes of under-eye bags, changes in contour and fluid retention therefore need to be distinguished. Persistent swelling should be examined, without turning its appearance into a diagnosis.

The useful question is not only “What colour are my dark circles?” but also “What has changed along with them?” A yellow tint in the whites of the eyes or the skin, dark urine, persistent itching, swelling or extreme fatigue give your doctor different information from a shadow under the eyes.

Liver disease can also remain without symptoms for a long time. The absence of these signs therefore does not prove that the liver is healthy. Conversely, their presence does not prove liver disease: it warrants looking for the cause.

You can explain what has changed, since when, and whether the signs appear together. The doctor can then examine your skin and assess your overall health without automatically attributing your dark circles to your liver.

Your family doctor or the doctor who usually treats you starts by asking about your history and examining you, looking for what contributes to the appearance under your eyes: pigment, visible blood vessels, a hollow, swelling or irritation. If other factors raise suspicion of liver disease, the diagnosis is also based on symptoms, medical history and, depending on the case, tests or imaging.

Be ready to mention any changes in weight or appetite you have noticed, how much alcohol you drink and a list of the medications, over-the-counter products and supplements you take. This information is part of the liver assessment when the situation calls for one.

Liver blood tests measure, among other things, enzymes such as ALT, AST, GGT and alkaline phosphatase, also called ALP. The results can guide the search for a liver problem, but on their own they generally cannot identify a specific disease. An abnormal result may require further tests to understand its cause.

Albumin is a protein made by the liver. A low level can occur with liver disease, kidney disease or another health problem. The doctor interprets it along with the other results: a single measurement does not establish the diagnosis.

These tests are ordered when there is a clinical suspicion. Discolouration under the eyes is not enough, on its own, to decide which ones to order; that choice is up to the doctor, based on your overall situation.

If cirrhosis is suspected, the doctor may choose one or more imaging tests. An ultrasound uses sound waves to show the structure of organs. An MRI provides detailed images of organs and soft tissues without X-rays. The choice depends on what the doctor wants to check, not merely on how your dark circles look.

These liver tests are the responsibility of your regular doctor. At CARE MD, the cosmetic assessment of dark circles includes checking what can be improved under the eyes; it is not a substitute for investigating a general medical condition.

Swelling under the eyes should be distinguished from discolouration. Some kidney diseases, such as nephrotic syndrome, can cause swelling around the eyes and in other parts of the body. Swelling around the eyes is not enough, on its own, to identify kidney disease.

For the heart, the signs to describe are instead shortness of breath during usual activities and swelling in the ankles, feet, legs or abdomen. They can accompany heart failure; on their own, they do not explain a pigmented dark circle.

If you also have unusual fatigue, tell your doctor. Anemia may be among the health problems to look for, depending on your situation, but discolouration under the eyes cannot be used to diagnose it. For the thyroid as well, the colour of dark circles is not enough to make a diagnosis. Your doctor can evaluate this possibility based on your symptoms and choose the appropriate tests.

Cancer: dark circles alone are not enough to conclude that there is cancer. Talk to your doctor about a persistent change or additional symptoms.

Red eyes are related to an eye health problem that needs to be examined by a doctor, not to cosmetic treatment of dark circles.