From the Guidelines
Periorbital ecchymosis is a serious condition that requires immediate medical evaluation, especially if it occurs without direct trauma to the eye area, as it may indicate a basilar skull fracture or other severe underlying condition 1.
Causes and Presentation
Periorbital ecchymosis, also known as "raccoon eyes" or "panda eyes," is bruising around the eyes that appears as dark discoloration, typically resulting from blood collecting in the soft tissues around the eye socket following trauma to the head or face. The condition can be associated with various signs and symptoms, including periorbital soft tissue swelling, hyphemia, subconjunctival hemorrhage, diplopia, restriction of ocular movement, or vision loss 1.
Management and Treatment
No specific medication treats the bruising itself, as it will resolve naturally over 1-2 weeks as the body reabsorbs the blood. Cold compresses can be applied for the first 24-48 hours to reduce swelling, followed by warm compresses afterward to help with absorption. Pain can be managed with acetaminophen (500-1000mg every 6 hours as needed) rather than NSAIDs or aspirin, which may worsen bruising 1.
Underlying Cause
The underlying cause of periorbital ecchymosis must be addressed, which may require hospitalization, observation, or surgical intervention if a skull fracture or intracranial bleeding is present. Imaging studies, such as CT or MRI, may be necessary to assess the extent of the injury and to evaluate for potential complications, such as orbital fractures or intraorbital foreign bodies 1.
Key Considerations
It is essential to recognize that periorbital ecchymosis can be a sign of a serious underlying condition, and prompt medical evaluation is crucial to prevent potential complications and improve outcomes. The presence of visual loss or visual field defects suggests direct or indirect injury to the globe or optic nerve, and immediate ophthalmologic evaluation is necessary 1.
From the Research
Definition and Causes of Periorbital Ecchymosis
- Periorbital ecchymosis (PE) is caused by blood tracking along tissue plains into periorbital tissues, causing discoloration in the upper and lower eyelids 2.
- The most common etiology of periocular ecchymosis is trauma, but it can also occur spontaneously 3.
- Spontaneous periocular ecchymosis (SPE) can be caused by various factors, including amyloidosis, neoplasms, raised intracranial pressure, vascular malformations, migraine, and atypical headache 3.
Clinical Features and Associations
- Periorbital ecchymosis is often associated with basal skull fractures, but it can also be associated with other injuries such as soft tissue injuries, convexity fractures, and facial fractures 2.
- The most common clinical feature associated with PE is cranial nerve injury, observed in 10 patients in a series of 36 cases 2.
- Other classic signs of basal skull fracture, such as Battle's sign, hemotympanum, cerebrospinal fluid otorrhea, and cerebrospinal fluid rhinorrhea, are rarely observed in patients with PE 2.
Treatment and Management
- Surgical intervention is required in some cases of PE, but most patients do not have injuries severe enough to require surgical intervention or post-discharge rehabilitation 2.
- Cooling of the periorbital region can reduce edema and ecchymosis, as well as pain, after rhinoplasty 4.
- Various prophylactic and therapeutic measures have been described in the literature to reduce postoperative periorbital edema and ecchymosis after rhinoplasty 5.