Milia Under the Eyes: What They Are and How They Are Removed

What Are Milia and Why Do They Form?

Milia (singular: milium) are benign, subepidermal keratin cysts — tiny pockets of trapped keratin protein sitting just beneath the outermost layer of skin 1Ref 1Gallardo Avila PP, Mendez MD (2023).Milia.Definition, pathophysiology, classification of primary vs secondary milia, and extraction as the standard removal method. Unlike whiteheads, they are not connected to the pore opening and do not contain oil or bacteria. Because they are enclosed by a thin layer of skin, they cannot release their contents on their own, which is why squeezing almost never works and can damage the thin, delicate under-eye tissue.

Clinicians distinguish two main types 1Ref 1Gallardo Avila PP, Mendez MD (2023).Milia.Definition, pathophysiology, classification of primary vs secondary milia, and extraction as the standard removal method:

• Primary milia arise spontaneously with no identifiable cause. They are most common around the eyes, on the nose, and on the cheeks. In newborns, they appear in up to 50% of cases and clear on their own within weeks; in adults, they persist without intervention.
• Secondary milia develop after the skin has been disrupted — by a burn, a blistering skin condition, dermabrasion, laser resurfacing, or prolonged use of heavy topical products. The healing skin can trap keratin as it regenerates, forming new cysts during recovery 1Ref 1Gallardo Avila PP, Mendez MD (2023).Milia.Definition, pathophysiology, classification of primary vs secondary milia, and extraction as the standard removal method.

Several factors raise the likelihood of milia in adults: thick or occlusive skincare products applied close to the lash line, cumulative sun damage that thickens the skin surface and impairs normal shedding, and slower skin cell turnover with age.

What Actually Removes Milia?

The most reliable removal method is lancing and extraction performed by a trained clinician. The provider uses a sterile fine-gauge needle or no. 11 blade to pierce the thin skin overlying each cyst, then gently expresses the keratin contents — often with a comedone extractor 1Ref 1Gallardo Avila PP, Mendez MD (2023).Milia.Definition, pathophysiology, classification of primary vs secondary milia, and extraction as the standard removal method. The procedure is quick, requires no anesthesia, and when done by an experienced hand, carries a very low risk of scarring. Results are immediate.

Other options a dermatologist may discuss include 1Ref 1Gallardo Avila PP, Mendez MD (2023).Milia.Definition, pathophysiology, classification of primary vs secondary milia, and extraction as the standard removal method:

• Laser ablation or cryotherapy — effective for widespread or recurrent milia, and often preferred when multiple lesions need clearing in a single session.
• Topical retinoids — vitamin A derivatives that accelerate keratin shedding and may gradually resolve existing milia over several weeks to months, though they work more slowly than extraction. Retinoids have well-established evidence for modulating epidermal differentiation 2Ref 2Balado-Simó P, Morgado-Carrasco D, Gómez-Armayones S, et al. (2025).An Updated Review of Topical Tretinoin in Dermatology: From Acne and Photoaging to Skin Cancer.Retinoid mechanism — pleiotropic effects on epidermal differentiation and keratin turnover — underlying the rationale for use in milia prevention, and this same mechanism plausibly benefits milia — but direct, high-quality randomized trials specifically for milia are lacking, so the effect size is not precisely known.
• Chemical peels — a clinician-applied peel (glycolic acid, trichloroacetic acid) can help resurface the skin and reduce recurrence, but is not a rapid removal method.

Home extraction near the eye area is not recommended. The periorbital skin is among the thinnest on the body, and unsterile attempts risk bruising, scarring, and infection.

Could These Bumps Be Something Other Than Milia?

Several conditions can look like milia, particularly around the eyes. A dermatologist can usually distinguish them by clinical exam, with dermoscopy providing additional detail when the diagnosis is uncertain 3Ref 3Wang X, Sun J (2021).Dermoscopy and reflectance confocal microscopy for the noninvasive diagnosis of extensive periorbital milia en plaque.Dermoscopy as a clinical tool for noninvasive confirmation of periorbital milia before treatment.

Closed comedones (whiteheads) are the most common look-alike. They are softer to the touch than milia and tend to occur alongside other acne-related lesions.

Syringomas are benign tumors derived from eccrine sweat gland ducts. They present as clusters of small, firm, yellowish or flesh-colored papules specifically under the lower eyelids — usually bilateral and more common in women 4Ref 4Müller CSL, Tilgen W, Pföhler C (2009).Clinicopathological diversity of syringomas: A study on current clinical and histopathologic concepts.Syringomas as eccrine-derived benign neoplasms clustering under the lower eyelids — key differential diagnosis for periorbital milia. They are cosmetically similar to milia but are structurally different and require separate treatment (laser, electrodesiccation).

Xanthelasma palpebrarum are soft, yellowish plaques near the inner corners of the eyelids. A systematic review found that patients with xanthelasma have significantly higher serum levels of total cholesterol and LDL compared with controls, making a fasting lipid panel a reasonable next step if this diagnosis is suspected 5Ref 5Chang HC, Sung CW, Lin MH (2020).Serum lipids and risk of atherosclerosis in xanthelasma palpebrarum: A systematic review and meta-analysis.Xanthelasma palpebrarum association with elevated LDL and total cholesterol — rationale for lipid panel when this diagnosis is considered.

Sebaceous hyperplasia — enlarged sebaceous glands — can produce small yellowish bumps that may be confused with milia, particularly on the forehead and central face.

If a bump has grown, changed color, bleeds, or crusts, it should be evaluated — milia do not behave this way.

How Can You Prevent Milia from Coming Back?

Prevention is primarily about reducing the conditions that trap keratin beneath the skin.

Gentle chemical exfoliation — a product containing glycolic acid or lactic acid, used two to three times per week — encourages normal shedding of dead skin cells and can reduce the frequency of new milia forming. These alpha hydroxy acids work at the surface and are generally well tolerated around the eye area when applied carefully.

Choose lighter eye-area formulations. Heavy, occlusive creams (particularly those high in petrolatum or lanolin applied very close to the lash line) create an environment where keratin shed cannot escape. Non-comedogenic formulations labeled for periorbital use are preferable for milia-prone skin.

Daily broad-spectrum sunscreen matters. UV exposure thickens the stratum corneum over time and impairs normal desquamation — both of which promote milia formation.

Prescription retinoids used for acne or photoaging can reduce milia as a secondary benefit by accelerating skin cell turnover. However, retinoids also cause initial dryness and irritation, and are best supervised by a clinician.

These habits reduce recurrence but will not rapidly clear milia that are already present — for that, in-office extraction remains the standard approach.

When to See a Dermatologist

Milia are harmless and do not require treatment from a medical standpoint. However, if they are cosmetically bothersome, a board-certified dermatologist or a trained aesthetician working under clinical supervision can clear them efficiently. Most patients see immediate improvement after a single extraction session, though new milia can form over time if the underlying contributing factors are not addressed.

See a dermatologist promptly if any periorbital bump:

• Grows over weeks to months
• Bleeds, crusts, or becomes tender
• Changes color or develops an irregular border
• Appears suddenly in large numbers across a wider area of skin

These features are not consistent with milia and warrant evaluation to rule out other skin conditions.