How do you manage a black eye?

Management of Black Eye

Apply cold compresses to the affected eye for 20 minutes every hour for the first 24-48 hours to reduce swelling and pain. This approach helps minimize edema and ecchymosis while promoting comfort and healing 1.

Initial Assessment

• Assess visual acuity immediately using a standard eye chart
• Check pupillary response and eye movements
• Perform confrontation visual field examination
• Conduct direct ophthalmoscopy to evaluate for deeper injury
• Look for signs of globe rupture (irregular pupil, decreased eye pressure, visible tissue prolapse)

Treatment Protocol

First 24-48 Hours

1. Cold Therapy

   • Apply cold compresses for 20 minutes every hour
   • Use ice packs wrapped in cloth (never apply ice directly to skin)
   • Position the compress gently without applying pressure to the eye
   • Avoid touching the eye if corneal abrasion is suspected

2. Pain Management

   • Oral analgesics (acetaminophen or NSAIDs) as needed
   • Avoid aspirin which may increase bleeding

3. Position

   • Keep head elevated, including during sleep
   • Avoid bending or straining activities that increase pressure to the head

After 48 Hours

1. Switch to warm compresses if swelling persists
   • Apply for 20 minutes 3-4 times daily
   • Place warm compress near but not touching the eyelid to avoid distorting corneal shape 2
   • Maintain temperature around 40°C (warm, not hot)

Warning Signs Requiring Immediate Referral

Refer immediately to an ophthalmologist or emergency department if:

• Decreased visual acuity
• Double vision
• Severe pain not relieved by analgesics
• Blood visible in the anterior chamber (hyphema)
• Irregular pupil shape or size
• Inability to move the eye in all directions
• Protruding eyeball or visible tissue

Important Considerations

• Never apply pressure to an eye with suspected globe rupture; use an eye shield instead 3
• Avoid black tea compresses on eyes with corneal epithelial defects as they can cause corneal staining 4
• If corneal abrasion is present, antibiotic prophylaxis may be needed (e.g., moxifloxacin drops four times daily) 5
• For persistent symptoms beyond 7-10 days, refer to an ophthalmologist to evaluate for orbital fracture or other complications

Follow-up

• Most uncomplicated black eyes resolve within 1-2 weeks
• If swelling and discoloration persist beyond 2 weeks, further evaluation is warranted
• Recommend protective eyewear for sports and high-risk activities to prevent recurrence