Milia: What Those White Bumps Under Your Eyes Really Are

What Are Milia?

Milia (singular: milium) are tiny, benign subepidermal keratin cysts. Each one is a small, firm, white or pale-yellow papule, typically measuring 1–2 mm in diameter. Unlike a whitehead (closed comedone), a milium is not filled with oil — it is filled with tightly packed keratin protein. The overlying skin is intact; there is no follicular opening, which is why you cannot squeeze a milium out the way you can a blackhead.

Milia are common, harmless, and often resolve without intervention. They are most frequently found on the:

• Undereye area and upper cheekbones
• Nose and nasal crease
• Forehead and temples
• Eyelids (including the lid margin)
• Chin

They can appear anywhere on the face and, less commonly, on the trunk.

Primary vs. Secondary Milia: What's the Difference?

The clinical classification of milia distinguishes between two fundamentally different origins:

Primary Milia

Primary milia arise spontaneously, without a preceding identifiable injury or skin disorder. The two most common forms:

Neonatal milia: Present in up to 40–50% of newborns. These appear on the nose, cheeks, scalp, and eyelids within the first weeks of life and almost always resolve completely within the first month without any treatment. The related Epstein pearls (milia on the palate) and Bohn nodules (milia on the gum ridge) are similarly transient.

Adult primary milia: Can develop at any age. The cause is not fully understood — they appear to arise from the eccrine sweat gland ducts or the outer root sheath of the hair follicle, where a small fragment of epithelium becomes enclosed beneath the skin surface and begins producing keratin in isolation.

Secondary Milia

Secondary milia develop after a trigger that disrupts normal epidermal repair. Common triggers include:

• Burns and scalds
• Dermabrasion, laser resurfacing, and chemical peels
• Blistering skin disorders (bullous pemphigoid, epidermolysis bullosa, porphyria cutanea tarda)
• Radiation therapy
• Certain topical medications, including phenols and high-concentration corticosteroids
• Prolonged topical steroid application

In secondary milia, the cysts form as the skin heals and small fragments of epithelium become trapped below the repaired surface.

Why Do Milia Form Under the Eyes Specifically?

The periocular area — particularly the undereye and upper cheekbone — is the most common location for adult primary milia for several reasons:

1. Thin, delicate skin. The undereye skin is among the thinnest on the body, making small subsurface cysts more visible and palpable.
2. Minimal sebaceous gland activity. Paradoxically, areas with fewer oil glands produce milia more readily — oil and dead cells are the raw material of acne comedones, but milia form independently of sebum.
3. Slow cell turnover. The periocular skin has a lower natural exfoliation rate, allowing small pockets of epithelium to become enclosed before keratin can exit normally.

Milia vs. Other White Bumps: A Quick Comparison

If white bumps under the eyes are numerous, slightly larger, and symmetric, they may be syringomas (benign sweat gland tumors) rather than milia. A dermatologist can distinguish them clinically; syringomas require different treatment (electrocautery, laser).

Do Milia Need Treatment?

No — not medically. Milia are harmless, cause no symptoms, and most primary milia eventually resolve spontaneously. The decision to treat is entirely cosmetic.

However, milia that persist for months, develop in cosmetically prominent areas, or multiply warrant professional evaluation to confirm diagnosis and discuss removal options.

How Are Milia Removed?

Professional Extraction (Most Effective)

A dermatologist or trained aesthetician makes a tiny incision in the skin surface over the milium with a sterile lancet, needle, or scalpel and then uses a comedone extractor to gently press out the keratin contents. The procedure is quick, minimally painful, and leaves no scarring when done correctly by a trained professional.

Do not attempt extraction at home. The wall of a milium is much harder than that of a comedone. Squeezing with fingers does not compress the cyst but instead damages the surrounding skin, causing post-inflammatory hyperpigmentation and risk of secondary infection.

Topical Retinoids

Retinoids — tretinoin (prescription), adapalene (OTC) — accelerate epidermal cell turnover, which helps the skin shed the superficial layers trapping the cyst. For widespread or recurrent milia, a topical retinoid applied nightly is a practical preventive and therapeutic approach. Expect 6–12 weeks of consistent use before seeing significant improvement.

Application note: the undereye area is sensitive — start with a low concentration applied every other night, avoiding the eyelid margin. Discuss with a dermatologist if treating milia very close to the lash line.

Chemical Exfoliation

Regular use of an AHA exfoliant (glycolic acid 5–10%, lactic acid 5–10%) promotes desquamation of the outer skin layers, which can help resolve milia over time and prevent new ones forming. This approach is slower than professional extraction but practical for management of recurrent, widespread milia.

Professional Procedures for Widespread Milia

For extensive or resistant milia, dermatologists may use:

• Diathermy and curettage — electrical current destroys the cyst wall, then contents are removed with a curette
• Cryotherapy — freezing with liquid nitrogen; effective but may cause transient discoloration
• Laser ablation — CO₂ or erbium laser precisely vaporizes the cyst; best for milia en plaque (extensive milia over a defined area)
• Chemical peels — superficial peels promote resurfacing of the skin trapping the cysts

Can Skincare Products Cause Milia?

There is a persistent belief that heavy, occlusive skincare products — particularly rich eye creams and petrolatum-based moisturizers — cause milia. The evidence is not strong for this claim in the general population. True milia originate from trapped epithelial fragments beneath the skin surface, a process that is not mechanically initiated by surface products.

That said, in people who are already prone to milia, prolonged use of thick occlusive products around the undereye area may create conditions that delay natural milia resolution or make them more noticeable. If you develop milia in areas where you apply heavy products, switching to a lighter, non-comedogenic eye formula is a reasonable adjustment.

Can Milia Be Prevented?

Prevention focuses on maintaining good epidermal cell turnover and skin barrier health:

• Use a gentle, pH-balanced cleanser twice daily to remove dead skin cell buildup
• Incorporate a chemical exfoliant (AHA or retinoid) into your routine 2–3 nights per week
• Choose non-comedogenic, lightweight formulas around the eye area if you are prone to milia
• After any resurfacing procedure (laser, chemical peel, dermabrasion), follow your clinician's post-procedure skincare protocol carefully to minimize secondary milia formation
• Avoid prolonged high-potency topical steroid application to the face

When to See a Dermatologist About Milia

Milia are benign and do not urgently require medical care. See a dermatologist if:

• You are unsure whether the bumps are milia, syringoma, closed comedones, or another condition
• Milia are extensive, multiplying, or not resolving after several months
• Milia develop after a known trigger (burn, blister disorder, laser procedure) — secondary milia sometimes require different management
• You develop a cluster of milia in an unusual distribution (milia en plaque) — this rare variant warrants evaluation to rule out underlying inflammatory conditions