A shiner, commonly known as a black eye, results from trauma to the face or head that causes bruising around the eye. Medically, this injury is termed a periorbital hematoma, signifying a collection of blood within the tissues surrounding the eye socket. While often alarming in appearance, a shiner is typically a superficial injury that resolves on its own. Understanding this common injury is important for managing symptoms and recognizing when the damage may be more serious.
The Anatomy of a Periorbital Bruise
A black eye begins when blunt force causes tiny blood vessels (capillaries) to rupture beneath the skin. The skin around the eye is exceptionally thin and lacks the protective padding of muscle and fat found elsewhere. This allows even a small amount of leaked blood to become highly visible, collecting in the loose soft tissues and forming a bruise that initially appears red or purplish-black.
Over several days, the body naturally begins reabsorbing the pooled blood. The dark color changes to shades of blue, green, and yellow as hemoglobin breaks down into different compounds. Gravity often causes the bruise to migrate downward, sometimes resulting in the discoloration spreading to the cheek or the other eye.
How Injuries Cause a Black Eye
A shiner most often results from blunt force trauma to the face, though the impact does not need to be directly on the eye itself. Any blow to the forehead, nose, or cheek can cause blood to track and accumulate in the loose tissue around the eye socket. Common scenarios include accidental falls, impacts sustained during sports, or bumping into a hard object.
The force of the impact can be transmitted through the facial bones, causing small blood vessels to break even if the skin surface remains intact. Certain medical procedures, such as cosmetic or nasal surgery, can also lead to a black eye as a side effect. In rare cases, bruising around both eyes, sometimes called “raccoon eyes,” can signal a fracture at the base of the skull.
Immediate Care and Home Treatment
The initial step in treating a simple black eye is to apply a cold compress immediately following the injury. Cold application constricts the blood vessels, which helps to minimize internal bleeding and reduce both swelling and pain. An ice pack or a bag of frozen vegetables should be wrapped in a clean cloth to prevent ice from directly touching the skin.
The compress should be held gently to the affected area for cycles of 10 to 20 minutes at a time, repeated several times an hour during the first 24 to 48 hours. It is important to avoid placing any pressure directly onto the eyeball itself while applying the cold. Keeping the head elevated, particularly while sleeping, can also help reduce swelling by allowing gravity to assist in fluid drainage.
After the first 24 to 48 hours, switching to a warm compress can help speed up the healing process. Warmth increases blood flow to the area, promoting the reabsorption of collected blood. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can be used for discomfort, but aspirin should be avoided as it may thin the blood and increase bruising.
Signs That Require Medical Attention
While most shiners are harmless, some symptoms indicate a more significant injury. Any change in vision, such as blurriness, double vision, or a complete loss of sight, should prompt an urgent visit to a healthcare provider. Severe, persistent pain or the inability to move the eye normally are also signs of potential complications.
The presence of blood in the colored or white part of the eye, known as a hyphema or subconjunctival hemorrhage, is another serious indicator. Additionally, look for an irregular pupil size or shape compared to the uninjured eye. If the injury was severe enough to cause a loss of consciousness, persistent headache, vomiting, or clear fluid leaking from the nose or ears, seek emergency care immediately, as these may signal a concussion or a skull fracture.