What is the best approach to managing Milia (small keratin-filled cysts) in the eye?

Understanding Milia Around the Eye

Milia are small, benign keratin-filled cysts that appear as tiny white bumps, typically 1-4mm in size, and while they are harmless and don't affect your vision, they can be removed for cosmetic reasons if they bother you. 1, 2

What Are Milia?

• Milia are superficial epidermoid cysts filled with keratin (a protein found in skin) that appear as small white or yellowish bumps on the skin 3, 2
• They commonly occur around the eyes, particularly near the inner corners and on the eyelids 4
• These cysts are completely benign and do not cause pain, vision problems, or other symptoms in most cases 5, 2
• Milia can occur spontaneously (primary milia) or develop after skin trauma, inflammation, or certain skin conditions (secondary milia) 3

Why Do They Occur?

• Primary milia develop spontaneously when dead skin cells become trapped beneath the skin surface rather than shedding naturally 3
• They may appear suddenly in large numbers (called "multiple eruptive milia") or gradually over time 3, 2
• Milia can temporarily appear during treatment of certain eyelid conditions like blepharitis, but these often resolve on their own 1
• In rare cases, they cluster in patches with surrounding redness (called "milia en plaque"), which is more cosmetically concerning 5, 4

Do They Need Treatment?

• Most milia are entirely asymptomatic and require no treatment unless they cause cosmetic concerns 5, 2
• They do not affect your eye health, vision, or quality of life 5
• Many milia will eventually resolve spontaneously over time, though this can take months to years 5

Treatment Options If Desired

If milia are cosmetically bothersome to you, several treatment options exist:

Professional Removal Methods

• Manual extraction by a dermatologist or ophthalmologist is the most common approach - the cyst contents are expressed after making a small opening in the skin 4
• Laser ablation using CO2 fractional laser or erbium:YAG laser provides excellent results with minimal scarring, particularly for periocular (around the eye) milia 5, 4
  • The erbium:YAG laser is especially safe for the delicate eyelid area because it provides precise tissue removal with minimal thermal damage 4
  • Treatment typically requires 1-2 sessions with good cosmetic outcomes 5
• Incision and curettage (scraping out the contents) can be performed for individual lesions 4

Important Considerations

• Conservative treatments and manual expression may result in recurrence, so laser treatment often provides more durable results 4
• Any treatment around the eyes should be performed by an experienced ophthalmologist or dermatologist to avoid complications like scarring or eyelid margin injury 4
• If milia recur after treatment, repeat procedures can be safely performed 5

When to See a Specialist

• If you're bothered by the appearance of milia and want them removed, see a dermatologist or ophthalmologist 5, 4
• If you notice sudden eruption of many milia, particularly if accompanied by other skin changes, evaluation is warranted to rule out underlying conditions 3
• If milia are associated with redness, discharge, or woody membrane formation on the conjunctiva (the clear tissue covering the white of the eye), immediate ophthalmology evaluation is needed as this may indicate a different condition requiring specific treatment 6

Key Takeaway

Milia around the eyes are harmless cosmetic findings that don't require treatment unless they bother you aesthetically. 5, 2 If removal is desired, laser treatment by an experienced specialist provides the best cosmetic outcome with minimal risk of scarring or recurrence. 5, 4