Smiling with Creepy Eyes
This is one of the four unnatural facial appearance variants. Its exaggerated smile and eyes can be identified at the window without equipment.
Quick Answer
Large black-pupil eyes, heavy under-eye bags, and a fixed oversized smile that does not match the normal patient.
Reject before treatment. Tasing the patient can make the anomalous smile disappear, so do not use that as proof that the patient is normal.
What Smiling with Creepy Eyes actually is
Smiling with Creepy Eyes is a visual-layer anomaly built around an expression rather than a body change. The patient keeps its normal species, colour, and build but presents with large black-pupil eyes, heavy under-eye bags, and a fixed oversized smile that does not match the normal model. It is a B-tier entry, but it carries one of the most punishing traps in the game.
When it shows up
It appears on standard arrivals with no cue. The trap is entirely in the response: tasing the patient can make the anomalous smile disappear, so a player who tases first and judges afterwards will see a normal patient and clear it.
Which layer catches it
The window view, judged on the stability of the expression. The tell is not that the smile is odd — it is that the smile does not change the way a normal patient expression does, and that it is paired with unusually dark pupils and under-eye bags.
How Smiling with Creepy Eyes reads in each layer
| Detection layer | What you see |
|---|---|
| Window | The primary layer. Observe the expression over several seconds. A fixed oversized smile that does not resolve is the tell. |
| Clipboard photo | Useful supporting evidence. The photo freezes the face, which removes the ambiguity of watching a live expression change. |
| CCTV | The expression persists on the feed. Do not treat a clean camera view as clearing the patient if the window smile was already abnormal. |
| Document | No documented interaction. This entry is decided by the face. |
Step-by-step: a real Smiling with Creepy Eyes encounter
- A patient arrives with matched species, colour, and build.
- You look at the face and hold the expression for a few seconds. The smile is oversized and fixed.
- You check the pupils, which are large and black, and the under-eye bags, which do not match the baseline.
- You resist tasing the patient, because tasing would remove the smile and make the patient look normal.
- You compare the clipboard photo, which shows the same fixed expression, then reject before treatment.
False positives
Normal things players reject by mistake while hunting this entry.
- Tasing the patient as a test and then clearing it because the smile vanished. The recorded guidance is explicit that tasing can remove the anomalous smile, which means the test destroys its own evidence.
- Rejecting a patient for smiling. Normal patients have expressions; the tell is a fixed oversized smile with black pupils and heavy under-eye bags together.
- Confusing it with Crooked Face. Both are smiles, but Crooked Face sets the eyes at different heights, while this entry pairs a wide smile with dark pupils and under-eye bags.
- Clearing the patient because the face looked normal a moment later, which is exactly the behaviour the entry is built to exploit.
Often confused with
Entries that share a tell with this one, and how to separate them.
- Frequently confused with Crooked Face; the differentiator is eye placement versus pupil darkness and under-eye bags.
- Shares the visible-teeth problem with the corrupted rabbit form, so a yellow rabbit with an oversized smile should be treated as this pattern rather than as a normal patient.
- Overlaps with X-rayed Face, where features also appear and disappear with expression changes, which is why "it looks normal now" is never a clean result on either entry.
What a wrong call costs
This is the entry most likely to produce a confidently wrong decision, because the standard instinct — use an item to test the patient — actively erases the tell. A player who tases first and looks second will clear a patient that should have been rejected and will usually believe the check was conclusive. The result is a failed arrival and a lost Journal reward with no obvious cause.
Recorded appearance and response
Appearance: The patient has large eyes with black pupils and prominent under-eye bags, paired with a large drawn-on smile.
Tell signs: Large black-pupil eyes, heavy under-eye bags, and a fixed oversized smile that does not match the normal patient.
How to handle: Reject before treatment. Tasing the patient can make the anomalous smile disappear, so do not use that as proof that the patient is normal.
Last re-checked against the live game on September 16, 2026. Last verified 35 days ago — re-check pending.
Smiling with Creepy Eyes FAQ
Does tasing a patient remove this anomaly?
The recorded behaviour is that tasing the patient can make the anomalous smile disappear. That is not the same as clearing the anomaly — it means tasing removes your evidence, so it should never be used as a detection test.
How do I tell Smiling with Creepy Eyes from Crooked Face?
Look at the eyes. Crooked Face sets the two eyes at different heights with mismatched sizes, while Smiling with Creepy Eyes keeps the eye placement normal but darkens the pupils and adds heavy under-eye bags.
The smile went away on its own. Is the patient normal?
Not necessarily. This entry is specifically documented as one where an anomalous expression can stop looking anomalous. Re-check the pupils and the photo rather than treating the disappearance as a clean result.
What tier is Smiling with Creepy Eyes?
B tier. The tier reflects the difficulty of catching it correctly rather than the severity of the consequence, and the tasing interaction is why a B-tier entry can still cost a run.
Related Guides
Other Appearance Check anomalies
Crooked Face · S
Crooked smile, sharp teeth, large mismatched eyes, or eyes positioned unusually high on the face.
Three Eyes · A
Three glowing red eyes, extra eye placement, or an eye count that does not match the patient's normal model.
Hollow Face · A
Dark hollow eyes, sunken facial features, twitching, and a hunched posture.
Twitching · C
Erratic jerking movements, unnatural head/limb twitches, movement pattern different from all normal patients.
Staring · B
Sustained direct eye contact, head rotation that follows the player, and a gaze that does not break normally.
Tiny Anomaly · C
Unusually tiny body size, high-pitched voice, short-tailed pink bunny model, or multiple glowing red eyes.
X-rayed Face · B
Small wide circular eyes, black pupils, realistic teeth, or an X-rayed-looking face that appears only in one expression.