Treatment of Black Eye in Children
The recommended treatment for a black eye in children includes cold compresses for the first 24-48 hours, followed by warm compresses, along with careful monitoring for signs of more serious injury. While a black eye (periorbital ecchymosis) is often a benign condition, it requires proper evaluation as it may indicate underlying facial fractures in up to 68.3% of cases 1.
Initial Assessment and Management
Immediate Care (First 24-48 Hours)
- Cold compresses: Apply cold compresses for 10-15 minutes at a time with 10-minute breaks in between
- Elevation: Keep the child's head elevated, including during sleep
- Pain management: Use age-appropriate over-the-counter pain relievers as needed (acetaminophen preferred)
- Avoid pressure: Do not press on the injured eye
After 48 Hours
- Switch to warm compresses: Apply warm compresses to help absorption of the bruise
- Continue elevation: Maintain head elevation to reduce swelling
Warning Signs Requiring Immediate Medical Attention
Monitor for these signs that may indicate a more serious injury:
- Vision changes or blurry vision
- Severe pain not relieved by over-the-counter pain medication
- Blood visible in the white of the eye (subconjunctival hemorrhage)
- Pupils of unequal size or abnormal pupil reaction
- Difficulty moving the eye in any direction
- Double vision (diplopia)
- Persistent swelling beyond 48 hours
- Discoloration spreading beyond the eye area
- Bleeding from the nose (epistaxis)
- Signs of infection (increased redness, warmth, discharge)
When to Seek Medical Care
Immediate Medical Evaluation Needed If:
- The injury was caused by significant trauma
- Child has difficulty opening the eye
- Visible damage to the eyeball
- Severe swelling that prevents eye examination
- Any visual disturbances
- Persistent pain despite treatment
Consider CT Scan Evaluation When:
Research shows that 68.3% of patients presenting with a black eye have an underlying facial fracture 1. Consider imaging particularly when accompanied by:
- Diminished skin sensation (highly specific for fracture)
- Double vision or eye movement disorders
- Palpable fracture steps
- Nosebleed
- Subconjunctival hemorrhage
- Subcutaneous emphysema
Special Considerations for Children
Children require special attention because:
- They may have difficulty articulating symptoms
- They are at risk for amblyopia if visual development is affected
- They may be more prone to complications from eye injuries 2
- Children under 10 account for 26% of ocular penetrations despite representing only 4% of eye injury presentations 2
Prevention of Future Injuries
- Protective eyewear for sports and recreational activities
- Age-appropriate supervision during play
- Child-proofing of home environments
- Education about eye safety
Follow-up Care
- Most uncomplicated black eyes resolve within 1-2 weeks
- Follow up with a healthcare provider if:
- Symptoms worsen
- New symptoms develop
- The bruising doesn't improve within 2 weeks
- There are concerns about vision changes
Remember that while most black eyes are benign, they can be associated with more serious injuries that require prompt medical attention. The high association between black eyes and underlying facial fractures (68.3%) emphasizes the importance of proper evaluation, especially in cases of significant trauma 1.