What does it mean to have raccoon eyes?
Raccoon eyes don’t mean dark circles under the eyes — they refer to bruises around the upper and lower eyelids resembling the eye markings of a raccoon. The bruising is similar to a black eye, but the cause is more likely related to a skull fracture or head trauma than a direct facial injury.
Raccoon eyes bruising is a medical symptom that needs to be assessed by a doctor. If you injured your head and haven't seen a medical professional yet, talk to one as soon as possible.
Raccoon eyes don’t always appear after the event that caused them. Bruises can range in color from dark blue and purple to red, green or orange-yellow and can become evident anywhere from one to three days after the incident. They will usually fade in about one to three weeks.
This condition is also sometimes referred to as raccoon sign, panda sign or periorbital ecchymosis (eh-chuh-MOW-sis), which is medical terminology for bruising around the eyes.
Primary causes of raccoon eyes
Raccoon eyes are caused by a collection of blood underneath the skin around the eyes. Besides trauma or injury, raccoon eyes can result from several different types of underlying conditions or factors. These can be infectious, surgical, vascular or systemic.
Injury or trauma
Because the blood vessels around your eyes are delicate, bleeding in this area can be caused by a minor injury as well as a serious one. Some of these injuries include:
- Broken capillaries (small blood vessels) due to forceful vomiting, coughing or sneezing
- Irritation in the area, such as from plucking your eyebrows
- Fracture of the basal skull or the orbital bones around the eyes
- Crushing injury, such as to the thorax (the area around the chest)
- Blunt force trauma
In children, raccoon eyes could be a sign of trauma or abuse. If you suspect this is the case, seek help.
Infection
Some infectious conditions can lead to raccoon eyes. These include severe adenovirus infections in children and infected frontal sinus mucoceles (a buildup of mucus in the frontal sinuses that can lead to further infection and inflammation).
LEARN MORE: How do sinuses affect your eyes?
Surgery
Bruising around the eyes can also be caused by soft tissue damage during surgery, especially osteotomy (any procedure involving bone cutting and reshaping) or rhinoplasty (plastic surgery involving the nose).
Vascular
A range of vascular conditions — any condition that affects the blood vessels — can cause periorbital ecchymosis. These can include:
- Subarachnoid hemorrhage – Bleeding between the arachnoid (the middle membrane of the brain) and the pia mater (the innermost membrane)
- Giant cell arteritis – Inflammation of large blood vessels, especially in the head, neck and arms
- Intracranial hypertension – Pressure around the brain due to the buildup of cerebrospinal fluid
Some headaches, such as migraine, have shown raccoon eyes as a symptom. In the case of migraine, it is thought that slow blood clotting or widening of the blood vessels can lead to ecchymosis.
Systemic
Systemic diseases that affect the whole body can sometimes lead to periorbital ecchymosis. These include immune-mediated diseases like lupus erythematosus. Raccoon eyes can also appear with some forms of cancer, such as neuroblastoma or Kaposi sarcoma (a condition that causes abnormal tissue to form in different places around the body).
Other possible causes
Raccoon eyes can occur in some cases of amyloidosis. This condition develops when the body produces a protein called amyloid. The protein can build up in organs and tissues over time, eventually interfering with proper organ function. The accumulation of amyloid fibrils in the blood vessels around the eyes may cause those blood vessels to become damaged more easily, leading to raccoon eyes.
Only a small proportion of people with amyloidosis present with ecchymosis. However, raccoon eyes are a well-known manifestation. It is suggested they should be considered an early warning sign.
Because amyloidosis can be life-threatening if not treated properly, it is important to see a doctor promptly if raccoon eyes are present.
Treatments
Raccoon eyes usually heal on their own within one to three weeks, with the skin returning to a normal color over that time. If periorbital ecchymosis follows surgery, cold eye packs and resting or sleeping in an elevated position may help reduce eye swelling and get rid of raccoon eyes. Recovery after surgery can take longer.
Although they typically heal on their own, raccoon eyes may be a sign of a different condition that requires treatment. Depending on the cause of the raccoon eyes, lack of adequate treatment can lead to the following:
- Blindness or hearing loss
- Brain bleeding or infection
- Facial paralysis
- Head or facial deformities
- Coma
- Meningitis
- Injury to the eyeball or cranial nerves
- Leaking of cerebrospinal fluid through the nose
- Injury to the axons or hypothalamic-pituitary axis in the brain
- Pneumocephalus (air trapped within the skull)
It is important to see a doctor to make sure raccoon eyes aren’t a sign of a potentially serious condition that needs treatment.
When to call a doctor
If raccoon eyes appear following a head injury, seek immediate medical attention so doctors can determine the extent of the injury. You should also seek urgent care if you experience raccoon eyes with any of the following:
- Fluid leaking from the ears or nose
- Salty taste in the throat
- Confusion or disorientation
- Sudden change or loss of vision
While raccoon eyes could be the body’s response to surgery or mild trauma, they could also be associated with a serious condition. Seeing a doctor is the best way to determine the cause.
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