Purpura around the eyes describes a condition where small blood vessels leak blood into the surrounding skin, resulting in purplish patches or bruising. While often resembling common bruising, its appearance signals an underlying issue rather than a direct injury. This condition can manifest in one or both eyes.
Understanding Purpura Around the Eyes
Purpura around the eyes is often called “raccoon eyes” or “panda eyes” due to the dark discoloration encircling the orbital area. This appearance stems from increased fragility of small blood vessels, leading to blood escaping into the surrounding tissues. The skin in the periorbital region is particularly thin and delicate, making its blood vessels more susceptible to leakage.
Even minor vascular fragility can result in noticeable bruising in this thin-skinned area. When blood leaks from these fragile vessels, it pools under the skin, creating the characteristic purplish discoloration. This makes the periorbital area especially prone to displaying such signs when systemic vascular issues are present.
Underlying Causes of Purpura Around the Eyes
Purpura around the eyes often indicates underlying systemic conditions, particularly certain hematological disorders. A primary association is with AL amyloidosis, a rare disease characterized by the buildup of an abnormal protein called amyloid in various organs. This amyloid protein can infiltrate blood vessel walls, causing them to become fragile and prone to leakage. Although less than 15% of individuals with AL amyloidosis experience periorbital purpura, its presence is highly suggestive of this diagnosis and should prompt medical investigation. Amyloid deposits can impair the functioning of organs such as the heart, kidneys, liver, spleen, nervous system, and digestive tract. The vascular infiltration by amyloid fibrils contributes to the increased fragility observed in the periorbital area.
Other hematological disorders can also manifest with periorbital purpura due to similar mechanisms of vascular fragility. Multiple myeloma, a cancer of plasma cells, is one such condition. Monoclonal gammopathy of undetermined significance (MGUS), where abnormal proteins are produced, is also linked, as it can precede multiple myeloma or AL amyloidosis. Light-chain deposition disease (LCDD) is another related disorder where fragments of light-chain proteins deposit in tissues, inducing vascular fragility and potentially causing “raccoon eyes.” Unlike amyloid, LCDD deposits are granular and non-fibrillar, yet they similarly compromise vessel integrity.
When to Seek Medical Attention
The appearance of purpura around the eyes, especially without any history of trauma or injury, warrants immediate medical evaluation. While it may resemble a common bruise, its non-traumatic onset suggests an internal cause requiring professional diagnosis. This symptom serves as a distinctive diagnostic clue for serious underlying conditions.
Prompt investigation is important because conditions like AL amyloidosis can affect multiple organs and lead to severe complications if left undiagnosed and untreated. Early identification of the underlying cause allows for timely intervention and management, which can significantly influence health outcomes. Consulting a healthcare provider ensures appropriate diagnostic tests are performed to determine the exact reason for the purpura and to initiate any necessary treatment.