Periorbital Ecchymosis Differential Diagnosis
Single Most Likely Diagnosis
- Trauma: The most common cause of periorbital ecchymosis is trauma to the face, which can result from a fall, a fight, or an accident. This is due to the rich vascular network around the eyes and the thin skin in this area, making it prone to bruising.
Other Likely Diagnoses
- Basal Skull Fracture: A fracture at the base of the skull can cause ecchymosis around the eyes due to the tracking of blood along the fascial planes.
- Nasal Fracture: A broken nose can also lead to periorbital ecchymosis due to the close proximity of the nasal bones to the orbital area.
- Surgical Procedures: Recent eye surgery or other facial surgeries can result in periorbital bruising.
- Infections: Certain infections like orbital cellulitis can cause swelling and ecchymosis around the eyes.
Do Not Miss Diagnoses
- Cavernous Sinus Thrombosis: Although rare, this condition is life-threatening and can present with periorbital ecchymosis, among other symptoms like proptosis and decreased ocular motility.
- Meningitis: In rare cases, meningitis can cause periorbital ecchymosis, especially if there is associated trauma or infection spreading from the sinuses.
- Subarachnoid Hemorrhage: While less common, a subarachnoid hemorrhage can lead to periorbital ecchymosis, particularly if there is an associated basal skull fracture.
Rare Diagnoses
- Amyloidosis: Systemic amyloidosis can cause periorbital ecchymosis due to the deposition of amyloid proteins in the blood vessels, making them more fragile.
- Hematologic Disorders: Certain bleeding disorders, such as hemophilia or thrombocytopenia, can increase the risk of bruising, including periorbital ecchymosis, even with minor trauma.
- Vascular Malformations: Rare vascular malformations around the eye can cause ecchymosis, either spontaneously or after minor trauma.
- Neoplasms: Very rarely, tumors in the orbital or facial area can cause periorbital ecchymosis by eroding into blood vessels or causing obstruction of venous return.