"dark circles" under the eyes

If your child has "dark circles under her eyes," this is not a sign of anemia.

These characteristic darker areas of skin, often somewhat bluish in hue, may be slightly puffy as well. This reflects congestion of the normal drainage of surface blood circulation of the face. The facial tissue above the angle of the mouth drains back through veins that course near the nasal cavities. Any condition that causes more or less chronic nasal or sinus congestion can produce sluggish flow in the area just beneath the eyes. The dark, puffy appearance may make the surrounding skin appear relatively pale, but it is not really so.

The common name for these dark circles is thus allergic shiners. We see this condition in children with other manifestations of allergic disease for which you should be alert:

  • large adenoids, manifested by mouth breathing, snoring, or even sleep apnea (these are not visible through the mouth)
  • chronically enlarged tonsils
  • a transverse crease of the nose just above the fleshy tip; often there is a line of tiny white cysts, suggesting microscopic little pimples

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