Small bumps around the eyes are one of the most common reasons people ask us, "What is this?" Two of the usual suspects are syringomas and milia. They can look alike at a glance, and both are harmless, but they form in different parts of the skin and they are treated very differently.
This guide explains how to tell them apart, what causes each one, the safest ways to remove them, and when a bump deserves a closer look.
Key takeaways
- Syringomas are small, firm growths of sweat duct cells. They are usually skin-colored or slightly yellow and often sit in clusters on the lower eyelids.
- Milia are tiny cysts filled with keratin, a skin protein. They are usually bright white, pearly and very close to the surface.
- Milia can often be removed in one quick office visit. Syringomas sit deeper, so they usually need laser or electrosurgery and can come back.
- Don't try to pop or pick either one at home, especially near your eyes.
What is a syringoma?
A syringoma is a benign growth that starts in the cells lining an eccrine sweat duct. It forms in the dermis, the layer below the surface of the skin, which is why it feels firm and doesn't have anything inside that can be squeezed out.
Syringomas are fairly common, affecting about 1% of people. They are more common in women and usually appear in the teen years or adulthood. Some families have several members with them, and they are more common in people with Down syndrome or diabetes.
What they typically look like:
- Round, firm bumps about 1 to 3 millimeters across
- Skin-colored, yellowish, translucent or, in darker skin, a little lighter or darker than the surrounding skin
- Clusters of bumps that look alike, often on both lower eyelids in a fairly even pattern
- Usually no symptoms, though some people notice itching when they are hot or sweating
The lower eyelids and upper cheeks are the classic spots. Syringomas can also appear on the forehead, neck, chest, armpits and other areas. A less common eruptive form shows up as many bumps across the chest and trunk.
What are milia?
Milia (one is called a milium) are tiny cysts that form when keratin gets trapped just under the surface of the skin instead of shedding normally. Because they sit so close to the surface, they look like small white or cream-colored pearls.
Milia are extremely common. Up to half of newborns have them, usually on the nose and cheeks, and those clear on their own within weeks. In children and adults, milia tend to appear on the eyelids, cheeks and forehead.
Dermatologists group them into a few types:
- Primary milia form on their own, with no clear trigger.
- Secondary milia form after the skin has been damaged or irritated, such as after burns, blistering rashes, long-term sun damage, some skin procedures or long-term use of steroid creams.
- Rare forms can appear on a raised patch of skin or suddenly in large numbers.
Syringoma vs. milia: how to tell them apart
Only an exam can confirm what a bump is. A dermatologist can usually tell them apart with a close look through a dermatoscope, a handheld magnifier with its own light, and a quick skin biopsy settles any doubt. These differences are a helpful starting point:
- Color. Milia are usually bright white. Syringomas are usually skin-colored or slightly yellow.
- Feel and depth. Milia look like tiny beads sitting right at the surface. Syringomas are firm bumps that sit a little deeper and blend into the skin around them.
- Size and pattern. Milia are often 1 to 2 millimeters and can be scattered or single. Syringomas are often 1 to 3 millimeters and tend to form even clusters on both lower eyelids.
- What is inside. A milium has a small core of keratin that a dermatologist can remove through a tiny opening. A syringoma has nothing to drain because it is a small growth of duct cells.
Other bumps that can look similar
A few other common conditions show up in the same places, which is one reason a dermatologist visit is worthwhile:
- Xanthelasma. Soft, flat, yellow patches on the eyelids that can be linked to high cholesterol.
- Sebaceous hyperplasia. Yellowish bumps from enlarged oil glands, often with a small dip in the center.
- Flat warts. Small, flat-topped bumps that can spread with shaving or picking.
- Basal cell carcinoma. The most common skin cancer, often a pearly or shiny bump that grows, bleeds or won't heal.
Treating milia
Milia in babies are left alone because they go away on their own. In older children and adults, milia can last for months or longer, and treatment is simple when they are bothersome. Our milia treatment page covers the options in more detail:
- Extraction (de-roofing). The dermatologist makes a tiny opening with a sterile needle or blade and gently presses out the keratin. It takes a few minutes and usually leaves little or no mark.
- Topical retinoids. Adapalene gel or prescription tretinoin can help clear milia and prevent new ones, especially when there are many.
- Chemical peels. Gentle peels can help with milia that keep coming back. Learn more about our chemical peels.
- Other office treatments. Stubborn or widespread milia may respond to light electrosurgery or laser treatment.
Please don't squeeze milia at home. Unlike a whitehead, a milium has no opening, so pressing on it mostly damages the skin around it. Near the eyes, that can lead to infection, scarring or injury.
To lower your chances of new milia, choose lightweight, non-comedogenic eye creams, wear sunscreen and sunglasses every day, and use steroid creams on the face only as long as your doctor recommends. There is no proven way to prevent syringomas.
Treating syringomas
Syringomas don't need treatment for medical reasons. Many people choose removal because the bumps bother them cosmetically. Because syringomas extend into the deeper layer of skin, creams and extraction don't remove them. Treatments that can help include:
- Laser treatment. A CO2 or erbium laser can precisely vaporize or flatten syringomas, often over more than one session. See our CO2 laser resurfacing and Sciton laser pages to learn more about these devices.
- Electrosurgery. A fine-tipped instrument uses a small electric current to shrink each bump.
- Surgical removal. Cutting out a syringoma can work for a few isolated bumps, but it is used less often around the eyes.
- Medicines. Retinoids and a few oral medicines are sometimes tried for widespread syringomas, with mixed results.
Go in with realistic expectations. Syringomas can return, and several sessions may be needed. Side effects can include redness, lighter or darker patches and scarring. The risk of pigment change is higher in darker skin, and eyelid skin is thin, so a careful, conservative approach from an experienced dermatologist gives the best result.
When to see a dermatologist
Book a visit if:
- A bump is new, growing, bleeding, crusting or not healing
- You have a single shiny or pearly bump rather than a cluster of similar ones
- You notice flat yellow patches on your eyelids
- Many bumps appeared suddenly on your face or body
- A bump sits on the edge of your eyelid or affects your lashes or vision
- You would like the bumps removed safely
Frequently asked questions
Are syringomas or milia cancer?
No. Both are benign. A dermatologist can confirm the diagnosis and rule out look-alikes, such as basal cell carcinoma, that do need treatment.
Can I pop milia myself?
We don't recommend it. Milia have no natural opening, and squeezing them can scar the skin or cause infection, especially around the eyes. Extraction in the office is quick.
Do syringomas go away on their own?
Usually not. They tend to stay the same or slowly increase in number over the years. They are harmless, so treatment is your choice.
Is removal covered by insurance?
A visit to diagnose a new or changing bump is often covered. Removing milia or syringomas only for appearance is usually considered cosmetic and is typically not covered. Coverage varies, so check our insurance page and ask our team when you book.
Book a visit
If you have small bumps around your eyes and aren't sure what they are, our dermatologists can tell you in one visit and walk you through your options. Learn more about milia treatment and our medical dermatology care, find an office on our locations page, or book an appointment online.