Periorbital hyperpigmentation (POH) is a commonly known aesthetic condition causing marked psychological stress and disfigurement. There is no sufficient information about the etiology, pathogenesis and clinical features. POH is caused by numerous factors that may be internal and external including genetic, excessive pigmentation, periorbital puffiness, visible underlying blood vessels (veins and capillaries), shadowing effect, and tear trough. As regards the clinical aspect, it appears as round homogenous brownish or dark brown discolored patches in the periocular region always on both sides. Many factors have been established to explain the etiology and pathogenesis of POH, yet the exact mechanism is still unclear. Also, many treatment modalities have been applied to reach maximum efficacy with the least side effects. This review article aims to summarize the most recent and accepted concepts on etiology, pathogenesis and clinical features of POH which may help in finding the best lines of management with the most satisfactory outcomes.