“Raccoon eyes,” medically known as periorbital ecchymosis, describe bruising or discoloration around both eyes, resembling a raccoon’s markings. While often linked to physical trauma, this symptom can stem from various factors, from daily habits to serious medical conditions. Understanding its causes helps determine its seriousness and appropriate action.
Injuries and Trauma
The most common cause of “raccoon eyes” is head and facial injuries. A basilar skull fracture, a break in the bones at the base of the skull, is a significant concern. Blood from the fracture site can leak into surrounding tissues and pool around the eyes, creating the characteristic discoloration, which may develop 1 to 3 days after the injury.
Other facial fractures, such as those affecting the orbital bones, can also cause this appearance. When blood vessels are damaged, blood leaks into the soft tissues. The delicate skin and rich blood supply around the eyes make them susceptible to visible bruising, even from distant trauma. Discoloration typically appears hours to a day after injury as blood migrates to the surface.
Underlying Medical Conditions
Beyond trauma, “raccoon eyes” can indicate various medical conditions. Severe allergic reactions, especially angioedema, cause fluid accumulation around the eyes. This swelling can create a bruised appearance, primarily from fluid retention, not blood leakage. Its rapid onset distinguishes it from typical bruising.
Systemic diseases can also cause periorbital discoloration. Amyloidosis, where abnormal proteins accumulate, makes capillaries fragile and prone to spontaneous bleeding, leading to purpura around the eyes. Neuroblastoma, a childhood cancer, can cause orbital metastases that disrupt local blood vessels and tissues, resulting in periorbital ecchymosis. Bleeding disorders like hemophilia or severe thrombocytopenia (low platelet count) impair clotting, increasing spontaneous bleeding into tissues, often visible around the eyes.
Everyday Factors and Genetics
Many dark circles, colloquially called “raccoon eyes,” stem from everyday factors. Chronic sleep deprivation dilates blood vessels under the eyes, making them prominent through thin skin and creating a darkened appearance. Dehydration can also make skin appear thinner and underlying blood vessels more visible.
Aging thins the skin and reduces collagen and fat, making blood vessels more apparent. Genetics also play a role, as some individuals inherit thinner skin or more superficial blood vessels, predisposing them to darker circles resembling ecchymosis, even without injury or illness.
When to Seek Medical Attention
While some “raccoon eyes” are harmless, immediate medical evaluation is needed in certain scenarios. If discoloration appears after any head injury, fall, or accident, seek prompt medical attention. This could indicate a serious underlying injury, like a skull fracture or intracranial bleeding, and early diagnosis can prevent life-threatening complications.
Consult a doctor if “raccoon eyes” appear suddenly without trauma or with other concerning symptoms. These include severe headache, vision changes, persistent nausea or vomiting, clear fluid leaking from the nose or ears, confusion, or unexplained bruising. Also seek advice if the discoloration persists, worsens, or is linked to allergic reactions like difficulty breathing or widespread swelling.