Raccoon eyes, medically known as periorbital ecchymosis, describe the distinctive dark discoloration that appears around both eyes, resembling the mask of a raccoon. This bruising arises when blood leaks into the delicate tissues surrounding the eyes, creating a noticeable blue-to-purple or even red-to-black hue. The appearance is a symptom, not a condition itself, and can signal an underlying health issue.
What Causes Raccoon Eyes
The most recognized cause of raccoon eyes is trauma, particularly a basilar skull fracture. When such a fracture occurs, blood from the injury site can track down through the facial tissues and pool around the eyes, leading to the characteristic bruising. These bruises typically appear 1 to 3 days after the injury. Direct trauma to the face or eyes, such as a broken nose or cheekbones, can also cause bruising around the eyes.
Beyond traumatic injuries, raccoon eyes can arise from less common medical conditions. Amyloidosis, a rare disease where abnormal proteins called amyloid accumulate, can lead to fragile blood vessels. This fragility makes capillaries susceptible to leakage, resulting in bruising around the eyes, sometimes even from minor actions like a strong sneeze or cough. In children, neuroblastoma, a cancer that often spreads to the orbit, can present with raccoon eyes due to tumor tissue obstructing blood vessels around the eyes.
Recognizing Accompanying Signs and When to Act
Raccoon eyes, especially after a head injury, can be a sign of a serious underlying condition. Headaches, dizziness, nausea, and vomiting are common indicators of head trauma. Changes in vision, such as double vision or blurred vision, can also occur.
Other concerning signs include confusion, disorientation, or loss of consciousness. Leakage of clear fluid (CSF) from the nose or ears can signify a dural tear. Hearing changes, blood behind the eardrums, or facial weakness due to nerve damage also warrant immediate medical attention. Raccoon eyes, particularly with any of these symptoms or following a head injury, require prompt evaluation by a healthcare professional, often involving a visit to an emergency room.
Medical Diagnosis and Treatment
Diagnosing the cause of raccoon eyes involves a physical examination and medical history review. Imaging tests play a central role in identifying internal injuries, with a computed tomography (CT) scan of the head the most effective method to detect skull fractures or intracranial bleeding. While X-rays are less effective, CT scans can identify brain and skull injuries.
Treatment for raccoon eyes addresses the underlying cause. For trauma-related cases like basilar skull fractures, management often involves supportive care, such as bed rest and monitoring. Most simple skull fractures heal on their own over several months. However, if complications like persistent CSF leaks, significant brain injury, or large bone fragments exist, surgical intervention may be necessary to relieve pressure, stop bleeding, or repair damaged structures. For non-traumatic causes, such as amyloidosis or neuroblastoma, treatment focuses on managing the specific disease, which could involve chemotherapy or other targeted therapies.