black eye

Black eye
Classification and external resources
Illustrative of a "black eye".
ICD-10	S00.1
ICD-9	921.0

A black eye (periorbital hematoma) or 'shiner' (colloquial) is bruising around the eye commonly due to an injury to the face rather than an eye injury. The name is given due to the color of bruising. The so-called black eye is caused by bleeding beneath the skin around the eye. Sometimes a black eye indicates a more extensive injury, even a skull fracture, particularly if the area around both eyes is bruised (raccoon eyes) or if there has been a head injury.

Although most black eye injuries aren't serious, bleeding within the eye, called a hyphema, is serious and can reduce vision and damage the cornea — the clear, protective "window" at the front of the eye. In some cases, abnormally high pressure inside the eyeball (ocular hypertension) also can result.

When bilateral, it is also known as raccoon eyes.^[1]

Presentation and prognosis

Close-up of a black eye after a few days of formation. The blood has been absorbed, but the iron-laden pigments in the blood remain in the tissue leaving a discolouration that may persist from months to a lifetime

Most black eye injuries are minor and will heal themselves in about one week. Trauma near the eyebrow or places not directly on the eye may make the eyelid go black.

The dramatic appearance (discoloration purple black and blue and swelling) does not necessarily indicate a serious injury. The fatty tissue along with the lack of muscle around the eye socket allows a potential space for blood accumulation with minor injury. As this blood is reabsorbed, various pigments are released similar to a bruise, lending itself to the extreme outward appearance. Unless there is actual trauma to the eye itself, medical attention is generally not needed.

Associated conditions

Eye injury and head trauma may also coincide with a black eye. Some common signs of a more serious injury may include:

• Double vision
• Loss of sight and or fuzzy vision could occur
• Loss of consciousness
• Inability to move the eye or large swelling around the eye such as a hematoma
• Blood or clear fluid from the nose or the ears
• Blood on the surface of the eye itself or cuts on the eye itself
• Persistent headache

Treatment

Putting a raw steak on a black eye (an old wives' tale) has long been known to have no medicinal value. Putting potentially bacteria-laden meat on a mucous membrane or an open skin injury is ill-advised.^[2] Treatment for the black eye can include ice, heat, and anti-inflammatory medication.

To take care of a black eye:

• Using gentle pressure, apply a cold pack or a cloth filled with ice to the area around the eye. Take care not to press on the eye itself. Apply cold as soon as possible after the injury to reduce swelling, and continue using ice or cold packs for 24 to 48 hours.
• Be sure there's no blood within the white and colored parts of the eye.
• Seek medical care immediately if you experience vision problems (double vision, blurring), severe pain, or bleeding in the eye or from the nose.

If it was a severe blow that caused the black eye (something more than just bumping into a door), blowing one's nose could increase inflammation. Sometimes the injury fractures the bone of the eye socket, and blowing one's nose can force air out of the sinus adjacent to the socket. The air gets injected under the skin and makes the eyelids swell even more. It can also increase the chance of infection.^[3] Keep the head elevated (sleep with a few extra pillows, for example) to help limit swelling and pooling.

References

1. ^ Deakin CD (1995). "Bilateral periorbital hematoma (raccoon eyes) following thoracic crush injuries: case reports". J Trauma 38 (5): 816–7. doi:10.1097/00005373-199505000-00025. PMID 7760416. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0022-5282&volume=38&issue=5&spage=816. 
2. ^ eMedicineHealth, "Black Eye Treatment", 2007
3. ^ Jeffers, Sivertson, Smith (2007-08-27). "Black Eye: 5 Ways to Clear Up the Bruise". The Doctors Book of Home Remedies. http://www.mothernature.com/Library/bookshelf/Books/47/13.cfm. Retrieved 2007-07-15. 

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