Sunken Eyes

"Sunken eyes," or "enophthalmos," is a term used to describe the appearance of darker skin directly under your lower eyelids. This makes your eyes look as if they are sitting back inside the eye orbit. You may also hear this referred to as eye hollows. Common causes of sunken eyes include aging, eye trauma, or lack of sleep.

This article covers the symptoms, common causes, and treatment for sunken eyes and discusses when to see a health provider.

Symptoms of Sunken Eyes

Symptoms that often accompany sunken eyes include:

• Dark circles under the eyes
• Double vision (if the cause is an eye fracture)
• Dry eyes
• Upper eyelids that appear droopy or, conversely, pulled far back
• An asymmetry in the positioning of your eyes
• Eyes that appear tired

The positioning of the eyes on the face can contribute to sunken eyes. Normal eye positioning varies based on age, ethnicity, and sex. For this reason, having sunken eyes does not always indicate a medical problem that needs treatment unless you are looking for a cosmetic change.

Causes of Sunken Eyes

The most common causes of sunken eyes include aging, trauma to the eye, and lack of sleep. Certain medication, including prostaglandin analogs used to treat glaucoma, can also make eyes appear sunken.

Aging

With age, fat content in the eye's orbital cavity can emulsify, creating more space and making the eyes appear more sunken into the face, with a darker appearance under the eyelids. The skin under the eye also becomes thinner with age, which can contribute to the appearance of enophthalmos.

Eye Trauma

Sunken eyes also can occur due to eye trauma. Causes of eye trauma can occur from:

• Fighting
• Sports, such as a ball that hits near the eye
• Vehicle accidents

A type of injury called a blowout fracture—a fracture in one or more of the bones around the eye—is often associated with enophthalmos.

Typically, the eye's orbit, or eye socket, protects the eye and helps it maintain its positioning. Yet after eye trauma, volume can be lost from the eye's orbit. The muscles, fat, and tissue around the eye can become displaced. Depending on the extent of the damage, this can lead to a sunken eye.

Many cases of enophthalmos occur within two weeks after trauma. Sometimes, however, it may take a couple of months to appear.

Lack of Sleep

A lack of sleep also can cause sunken eyes. When you don't get adequate rest, the skin under your eyes may appear darker. You also may have puffy eyes or eyelids that appear to be drooping. Bloodshot eyes, and eyes that feel more dry than usual, are other potential signs of lack of sleep.

What Medications Can Cause Sunken Eyes?

Prostaglandin analogs, a type of medication used for glaucoma, can cause enophthalmos. The antiviral medications used to treat human immunodeficiency virus (HIV) can also cause sunken eyes.

Medications that affect your sleep and keep you awake may also make you appear more tired. This can give the appearance of sunken eyes. Some medicines that may affect sleep include:

• Cold medicines
• Medications with caffeine
• Steroids
• Selective serotonin reuptake inhibitors (SSRIs)
  

Medications that may cause weight loss also could lead to the appearance of sunken eyes. These include:

• Some antidepressants, such as Wellbutrin (bupropion)
• Medications to treat obesity

How to Treat Sunken Eyes

Sunken eyes do not always require treatment.

However, if you do not like how sunken eyes look, you can try to make a few changes on your own to help their appearance. This includes:

• Getting more sleep, so you feel and appear better rested
• Making sure to drink enough fluids throughout the day, as dehydration can contribute to the appearance of sunken eyes
• Quitting smoking as it can negatively affect the appearance of your skin as well as your overall health
• Applying creams that properly moisturize the skin area under the eye
• Using a cool compress on the eyes to lower inflammation

There are also cosmetic treatments for sunken eyes, including dermal fillers. This involves injecting materials such as hyaluronic acid to provide additional volume. The area of skin under the eyes is one area dermal fillers target.

Surgery is usually the most effective treatment for enophthalmos caused by an eye injury. Surgery can help the appearance of the eye and may address double vision if it's a problem. Medicines such as antibiotics and steroids may be used immediately after the eye injury to help prevent infection and reduce overall swelling.

Are There Tests to Diagnose the Cause of Sunken Eyes?

To diagnose the cause of sunken eyes, a healthcare provider will visually inspect your face and your eyes. You may be asked about any medications that you use. Make sure to mention all prescription and nonprescription drugs, including supplements. Let your healthcare provider know about any other ongoing health symptoms.

If you have sunken eyes due to trauma, a healthcare provider may use a computed tomography (CT) scan, magnetic resonance imaging (MRI), or X-ray to assess the damage.

When to See a Healthcare Provider

If the appearance of sunken eyes bothers you and they don't improve after home measures, such as getting more sleep and hydrating more, it may be helpful to see an eye doctor, such as an ophthalmologist, or other healthcare provider.

On your first eye doctor visit, you may be referred to an oculoplastic surgeon specializing in eye and face surgery if you're interested in cosmetic treatment.

Summary

Sunken eyes, or enophthalmos, describes the appearance of darker skin directly under your lower eyelids. This makes your eyes look as if they are sunken back into the eye orbit. Common causes of sunken eyes are aging, trauma to the area around the eye, and lack of sleep.

Sunken eyes do not always require treatment. You can try measures at home, such as getting more rest and properly hydrating. You can also get cosmetic treatments, like dermal fillers, if the look of sunken eyes bothers you. Surgery may be part of the treatment if sunken eyes result from trauma.

A Word From Verywell

Sunken eyes may not be serious, but many people want to find a solution to help improve their appearance. If you're unsure what's causing your eyes to appear sunken, it's a good idea to see a healthcare provider to determine the cause and discuss treatment options.