Periorbital Veins

Periorbital Veins are blue, green, purple or red veins that are prominent and visible around the eyes and eyelids.

Below are some example photos of these types of vein. Larger veins tend to appear green or dark purple. Smaller calibre vessels tend to appear purple or red.

These veins cause no issues in terms of function but sometimes the prominence of the vein can be a cosmetic nuisance. Many people find these veins unsightly and it is difficult to conceal these veins with make-up or foundation and for men this is not really an option.

These large blue veins near the eye can be treated effectively with Laser, but ut this treatment requires two key elements;

• Access to highly specialist lasers to deal with the various vein types. This technology is complex and expensive to invest in and cannot be done with standard aesthetic devices.
• The expertise of a specialist who has extensive experience of the tissue and vein interaction with highly powerful lasers around the eye. Extensive specialist training is needed (outside of the UK) and it takes many cases and years of execution to hone results in the delicate eye area.

There are a combination and interplay of factors that result in the increased prominence of these visible veins around the eye.

Genetic Predisposition

Changes in the skin structure and vein appearances around the eye have a significant hereditary component. Problems such as vein prominence around the eyes or significant skin laxity (dermatochalasis) tend to run in families.

Advancing Age

As we get older the anatomy of the eye area changes. Firstly the bony frame around the eye changes in shape. The increase in the vertical and oblique orbital diameter with age contributes to the loss of support of soft tissues around the eye. This in turn causes changes that result in orbital fat that pushes out against the skin around the eye stretching the skin and making veins around the eye more visible. The skin itself becomes thinner and more translucent.

Collagen density and elasticity in the skin around the eye also gradually reduces. This results in the loss of supporting tissue around the larger veins around the veins. These veins consequently dilate and expand due to the loss of dermal support and become more apparent. This coupled with the translucency of the thinner skin makes these large blue or green veins much more visible through the skin.

Skin type

Lighter skin types are more liable to develop the problem of visible blue veins around the eye. This is due to the fact that lighter skin is less elastic and collagen dense. Therefore the support around these veins reduces earlier in lighter skin types.

Darker skin types are naturally more collagen dense and retain elasticity. The darker skin also makes the problem of visibility less of an issue as the presence of more melanin in the skin above the vein leads to less translucency and reduced visibility.

Sun Exposure/Photodamage

Prolonged sun exposure contributes to the formation of large veins around the eye as UVA light penetrates and progressively degrades the collagen and elastin within the naturally thin skin around the eye (the skin around the eye is on average four times thinner than the skin of the face)

Sun damage further degrades and contributes to the loss of this skin integrity especially in lighter skin types especially as they have less natural melanin to protect the skin against UV effects.

Due to the cosmetic nature of this problem the NHS does not treat large prominent veins around the eye. This treatment is only available in the private sector in the UK.

Given the non-NHS cover, doctors (be that dermatologists, vascular radiologists, vascular surgeons or plastic surgeons) are not trained to treat these eye veins and have no experience or expertise in this area.

There are only a handful of private medical centres that have the expertise and are licensed to carry out this treatment type.

The treatment of these veins also requires powerful vascular lasers. These lasers are only available in a few NHS departments in the UK and use of this resource is not permitted for treatment of cosmetic conditions like eye veins.

Lack of experience in treating veins around the eye would make any attempt by an inexperienced user dangerous. Inappropriate settings can cause burn and scar around the fragile thin skin around the eye.

The judgement of correct settings by a specialist doctor requires thousands of laser vein cases to be performed to understand the relationship between depth of penetration, pulse width and energy/fluence. Knowledge and experience of placing internal ocular metal eye shields to protect the cornea and eye from laser is required by the treating Doctor.

The only other non-laser method of treatment is Sclerotherapy and around the eye area this is dangerous. This is because in the skin around the eye the blood vessels communicate closely with blood vessels that supply the retina with blood. Pushing liquid or foamed sclerosant through these veins carries a risk of blindness due to compromise of retinal circulation or air embolus. Some attempts have been made by using sutures (stitches) to tie off segments of the offending vein and then injecting with sclerosant in order to reduce the risk of sclerosant flow into the eye or brain circulation.

This sclerotherapy method is extremely cumbersome, unpredictable, experimental and dangerous. It is used in some centres around the world but it must be used in extremely experienced hands. Most doctors and specialists are not willing to undertake this risk and strongly advise against sclerosant use around the eye.

In contrast, the vascular Laser methodology in experienced hands is focussed on the visible large vein itself and will cause no danger to the retinal or brain circulation. The NdYAG laser type is the Gold Standard for safe and effective treatment of large blue veins around the eye.

Very often treatment for larger veins around the eye is refused by most dermatology or aesthetic clinics. Although this is appropriate sometimes patients are told incorrectly that it is unsafe to treat these veins as their destruction will compromise the circulation of venous blood around the eye. This is not correct.

Treatment with the NdYAG laser for these veins will not cause any compromise to the drainage of blood from the tissue around the eye. If a segment of vein is lasered the venous blood will merely be diverted around the multiple alternative vein pathways around the eye. In any case the body has a normal process of neovascularisation (formation of new blood vessels) when circulation is potentially compromised.

Due to inadequate understanding of light tissue interaction and poor experience/lack of training Pulse Dye Laser or IPL devices (Intense Pulse Light) are inappropriately used by some practitioners. Whilst this may help with generalised redness or fine capillaries around the eye it is completely inappropriate for the treatment of larger blue/green/purple/red veins near the eye. If it is attempted it will fail. Even if treatments are repeated this method will fail. Needless trauma will result and no successful sealing of the vessel will occur. This is due to the light energy from these types of Laser/IPL device being poorly absorbed by venous blood.

Dr Hussein uses an NdYAG 1064nm laser to treat the larger veins around the eye. This laser is the only appropriate laser device.

To use this laser safely and effectively around the eye requires the extensive knowledge and experience. DrH routinely performs periorbital vein treatment and has over a decade of experience and thousands of successful laser vein cases completed,

In cases where the vein can safely be treated over the bone external metal eye shields can be used. In cases where the vein is closer to the eye or on the eyelids internal metal eye shields will be inserted.

If however there are smaller red capillaries on the eyelids Dr Hussein will treat these with the 532nm KTP laser. This laser wavelength is more appropriate for smaller red vessels around the eyes vs the NdYAG laser but can still cause trauma to the eye and should again be used with the simple insertion of internal metal eye shields for protection.

In more complex cases where DrH deems it necessary, Ultrasound guided vascular treatment can be performed (see video). This involves the use of a high resolution ultrasound scanner to evaluate vein diameter. This allows for more precise assessment of vessel diameter and calculation of appropriate laser pulse width.

The use of high resolution ultrasound also allows DrH to evaluate when the vein has been adequately treated.

This video shows Dr H treating periorbital veins with the assistance of high resolution ultrasound to ensure complete safety and successful treatment of this patient’s eye veins.

• DrHConsult use the appropriate laser for each eye area vein type – NdYAG 1064nm vascular laser for larger vessels and the 532nm KTP laser for smaller blood vessels.
• DrHConsult routinely performs this procedure and performs the most periorbital vein cases per annum in the UK.
• DrHConsult has over a decade and several thousand laser vein cases successfully completed. This is essential in safe use of NdYAG laser around the eye for the treatment of periorbital veins
• DrHConsult has access to high resolution ultrasound to ensure complete safety and success of any eye area vascular case
• DrHConsult is highly experienced in the use of internal ocular shields – required to ensure access by laser to veins near the eye area to maximise safety
• DrHConsult is a UK specialised centre of excellence for Laser Dermatology and as such we only use techniques that are validated by strong medical evidence. The NdYAG laser is the only device that should be used in treatment of larger blue/green periorbital veins – any other laser device is inappropriate