Key Symptoms to Watch for with a Black Eye (Periorbital Hematoma)
Seek immediate medical attention if you experience vision changes, severe pain, or signs of increased pressure in the eye following a black eye, as these may indicate serious complications that can lead to permanent vision loss.
A black eye (periorbital hematoma) is typically a result of trauma to the eye area, causing blood to collect in the tissues around the eye. While most black eyes heal without complications, certain symptoms require urgent medical evaluation.
Warning Signs Requiring Immediate Medical Attention
Vision-Related Warning Signs
- Decreased visual acuity or blurry vision 1
- Double vision (diplopia) 1
- Vision loss (partial or complete) 1
- Seeing halos around lights 1
Eye Appearance and Movement
- Mid-dilated, asymmetric, or poorly reactive pupil 1
- Relative afferent pupillary defect (one pupil reacts differently to light) 1
- Limited eye movement or pain with eye movement 1, 2
- Proptosis (bulging of the eye) 1, 2
- Enophthalmos (sunken appearance of the eye) 1
Pain and Pressure Signs
- Severe or worsening pain 1
- Feeling of pressure in or behind the eye 3
- Pain that is not relieved by over-the-counter pain medications
Other Critical Warning Signs
- Bradycardia (slow heart rate) with eye pain 1
- Dizziness, nausea, or vomiting with eye pain (may indicate oculocardiac reflex from muscle entrapment) 1
- Loss of consciousness with eye pain 1
- Clear fluid leaking from the nose (possible cerebrospinal fluid leak indicating skull fracture) 1
Physical Findings That May Indicate Complications
Examination Findings of Concern
- Corneal swelling or edema 1
- Hyphema (blood in the anterior chamber of the eye) 1
- Retinal hemorrhages or cotton wool spots visible on fundoscopic exam 1
- Retinal emboli or vascular "boxcarring" 1
- Optic disc swelling 1
- Conjunctival injection (redness) that is severe or worsening 1
Time Course and Evolution
- A black eye typically appears within hours after trauma 4
- In cases without direct orbital trauma, black eyes may take approximately 4 hours to develop from seepage of blood from frontal scalp wounds 4
- The color typically evolves from red-blue initially to green-yellow as it heals
- Significant swelling that progresses rapidly or continues to worsen after 24-48 hours may indicate a more serious problem 2
Special Considerations
Potential Serious Complications
- Retrobulbar hematoma (blood collection behind the eye) - a vision-threatening emergency 3
- Orbital compartment syndrome (increased pressure in the orbit threatening vision) 3
- Orbital fracture with muscle entrapment 1
- Retinal or ophthalmic artery occlusion 1
- Globe rupture or penetrating injury 1
High-Risk Factors
- Use of blood thinners or bleeding disorders 5
- History of sickle cell disease 5
- Severe trauma, especially with loss of consciousness
- Underlying conditions like sinusitis that may complicate periorbital swelling 2
When to Return for Follow-up Care
Even if initial evaluation is reassuring, return for medical care if:
- Vision changes develop or worsen
- Pain increases significantly
- Swelling increases after 48 hours
- New symptoms develop
- Symptoms persist beyond 2 weeks
Remember that some serious complications of periorbital trauma may not be immediately apparent but can develop over hours to days. Early recognition and treatment of complications are essential to prevent permanent vision loss.