How Can Large Veins Under the Eyes Be Treated?

The lower eyelids have a very thin dermis and are prone to early atrophy, development of visible varicose and spider veins, and accumulation of hemosiderin or melanin deposits.
I am frequently asked to treat patients with varicose and spider veins in the lower eyelid. Although the skin of the lower eyelid heals well, I generally do not advise laser treatment for larger and blue varicose veins. The problem is that the overlying skin may hyperpigment, and more importantly, may burn.
Sclerosants are typically not recommended in this area because of the small risk of embolization.
The preferred treatment is laser for smaller capillaries, telangiectasia, and veins. For larger veins, I would advise selective surgical excision of the vein under local anesthesia.

I agree with many of the contributors that sclerotherapy should not be used in these areas. There are several papers now showing that this can be dangerous when injected in veins close to the eyes. If the veins are small and green/blue then endovenous laser can be used.
However over the last few years we have developed some techniques of performing phlebectomy under local anaesthetic and have recently removed a large vein from the side of the eye and going over the upper eyelid.This is not a simple phlebectomy technique but one we have developed at the Whiteley Clinics and we are currently writing the technique up for the scientific journals.