From the Guidelines
Periorbital ecchymosis is a serious condition that requires immediate medical attention, especially if it appears after head trauma, and treatment should prioritize reducing morbidity, mortality, and improving quality of life. Periorbital ecchymosis, commonly known as "raccoon eyes," is bruising around the eyes that appears as dark discoloration. It typically results from blood collecting in the soft tissues around the eyes following trauma to the head or face. This condition can be a serious warning sign of a basilar skull fracture and requires immediate medical attention.
Causes and Symptoms
- The periorbital area is prone to pigmentation, crow's feet, tear-trough hollowing, decreased skin elasticity, and melanosis, all of which reveal a person's age 1.
- Common side effects of treatments in this area include swelling and bruising 1.
- Periorbital ecchymosis can appear without direct trauma to the eye area, and its presence after head trauma, especially without direct injury to the eye area, or accompanied by clear fluid leaking from the nose or ears, vision changes, severe headache, or confusion, necessitates emergency medical evaluation 1.
Treatment and Management
- Treatment depends on the underlying cause but generally includes rest, ice application for 15-20 minutes several times daily during the first 24-48 hours, elevation of the head while sleeping, and over-the-counter pain relievers like acetaminophen (avoid aspirin or ibuprofen if bleeding is a concern) 1.
- For mild cases without other symptoms, the bruising typically resolves on its own within 2-3 weeks as the body reabsorbs the blood.
- In cases of periorbital ecchymosis, especially those associated with head trauma or other severe symptoms, immediate medical evaluation and appropriate antimicrobial therapy, such as vancomycin, should be initiated to prevent complications like orbital and central nervous system involvement 1.
Prevention and Future Directions
- Autologous platelet concentrates (APCs) have shown promise in skin rejuvenation and may be used to treat periorbital aging, including wrinkles and hyperpigmentation 1.
- Further studies are needed to determine the best way to administer APCs to the undereye area and to evaluate their safety and efficacy in combination with other treatments 1.
From the Research
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 is trauma, but rarely, patients can present with spontaneous periocular ecchymosis (SPE) 3
- SPE can be caused by various factors, including amyloidosis, neoplasm, raised intracranial pressure, vascular malformations, migraine, and atypical headache 3
Association with Other Injuries
- PE is most commonly associated with basal skull fractures 2
- PE can be associated with a variety of injuries, including soft tissue injuries, convexity fractures, and facial fractures 2
- Cranial nerve injury is a common clinical feature associated with PE, observed in 10 patients in one study 2
Treatment and Prevention
- Applying adhesive strips to the upper and lower eyelids can reduce postoperative periorbital edema and ecchymosis following rhinoplasty 4
- Cooling of the periorbital region can reduce edema and ecchymosis, as well as pain, after rhinoplasty 5
- Various prophylactic and therapeutic measures have been described in the literature to minimize postoperative periorbital edema and ecchymosis, including the use of silicone gel packs and local anesthesia 5, 6