Veins under eyes; what should I do?

The treatment of veins under the eyes is a bit controversial.  You have several options (other than doing nothing, which is always an option, as this is clearly aesthetic) - these options include laser, or sclerotherapy (which might be done with either liquid and foam), and microphlebectomies (taking the veins out thru tiny incisions).  Each treatment has relative risks, advantages and disadvantages.  With good eye protection and adequate skin cooling, an external YAG laser (1064nm) such as the Cooltouch Varia is an excellent choice - but it should be done by someone with a really good machine and plenty of experience.  Many physicians swear by sclerotherapy (injections of the veins) - this carries the very rare risk of blindness and  should be done with caution.  Very large veins can be treated with microphlebectomies. Whoever is doing your treatment should be an expert in whatever modality they use.  Hope that helps!

Under eye veins can vary in caliber and length, ranging from bluish varicose veins to light red spider veins. The treatment of larger varicose veins is very specialized and I have demonstrated my technique on the Doctors television show which can be found online. Treatment includes surgical removal with initiation of a skin brightening regimen to optimize skin thickness and collagen content. 
Associated dark pigmentation on the lower eyelid skin can be due to melasma, bluish veins, hemosiderin deposits, and hyperpigmentation.  
Topical regimens include: 
1.MelaClenz
2.Melarase AM
3.Melarase PM
4.Melapads
5.Replenish Retinoid Cream
Additional therapies for undereye rejuvenation include fractional laser, fractional RF, Covalent peels, and LED microneedling with Replenish serum. The video demonstrates an analysis of varicose veins.
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Laser treatment is one option that has proven effective for veins around the eyes. I would suggest consulting with a vein specialist who has experience treating veins around the eyes before considering any other treatment options.

I prefer microphlebectomy as the technique of choice and occasionally employ sclerotherapy or laser. H Karamanoukian MD FACS

We have excellent results with VeinGogh (ohmic thermolysis).Unlike laser, instant results and no risk of hyper- or hypo- pigmentation.Depending on size of veins, may take more than one treatment.

it's hard to see the veins in the pictures but I have had excellent results treating veins under the eyes with YAG laser.  There are no needles or injections needed when you do laser.  It is important to take the necessary precautions to prevent any laser exposure to the eye.  I usually use internal eye shields (like big contact lenses) to protect the eye prior to laser treatment.  It only takes a few seconds to insert and remove these.  I put numbing drops in the eye first so there is minimal discomfort.  My patients have been very pleased with the improvement and the lack of downtime.  It is important to see a laser expert.Regards,Dr. Ort

I treat the veins you posted with a combination of sclerotherapy and fine needle radio frequency with very excellent results.  It may require more than one treatment.  Other options would be laser, IPL or VeinWave.