“Raccoon eyes,” or periorbital ecchymosis, refers to large dark rings around the eyes. The bruising and discoloration can signify a few different conditions that cause internal bleeding near the eyes.
The condition is not caused by lack of sleep or cosmetics but is the result of a medical condition or injury. Diagnosis, treatment and recovery time depend on what has caused it.
Medically known as periorbital ecchymosis, this condition describes bruising and discoloration around a person’s eyes that resemble the dark circles around a raccoon’s eyes.
The blood collecting in the soft tissues around the eyes causes bruises, which can vary in color from red to dark purple. The size of the bruises may also vary depending on the cause and type of injury.
Raccoon eyes are usually a sign of a serious condition that should be diagnosed and treated immediately.
Traumatic events, or a fracture, typically cause raccoon eyes. Other conditions can contribute to the symptom as well, but they are less common.
Basal skull fracture
Basal skull fractures (BSF) are the most common cause of raccoon eyes.
A basal skull fracture involves breaks in the bones that make up the base of the skull, including the temporal bone, occipital bone, sphenoid bone, or ethmoid bone.
These breaks are most likely due to traumatic events, such as car accidents, falling from great heights, and sports injuries. Breaks in these areas are not always apparent on X-rays and may be easy to miss at first.
Raccoon eyes may take hours or days to develop and may slip by the initial diagnosis at an emergency room or intensive care unit.
Some procedures involved with brain surgery, such as a craniotomy, can also cause raccoon eyes. A craniotomy is a procedure in which surgeons remove a part of the skull to expose the brain.
Surgeons replace the piece of the skull, but if it causes bleeding by rupturing the meninges, the person will likely develop raccoon eyes.
Raccoon eyes are also likely to show up if the thin bones surrounding the eyes break. These are the familiar black eyes caused by facial injuries that can occur on either side of the face.
A broken nose, broken cheekbone, and broken eye socket are other possible causes.
Amyloidosis occurs when an abnormal protein called amyloid builds up in the organs of the body. If amyloid builds up in the capillaries, they can become weak and break. When this happens, a person may develop raccoon eyes after a simple action, such as coughing, sneezing, or rubbing their eyes.
The symptoms of amyloidosis can vary drastically depending on where the protein is building up, and they can affect each person differently.
Certain cancers, such as neuroblastoma, may also cause raccoon eyes to appear.
Neuroblastoma refers to cancers that grow in developing nerve cells, and are found anywhere along the sympathetic nervous system. Neuroblastoma occurs most often in infants and children.
Rhinoplasty is plastic surgery that involves restructuring the bone and cartilage in the nose.
This procedure is carried out to improve the function of the nose or change its form to make it more appealing. Depending on the extent of the surgery, it is possible for rhinoplasty to cause raccoon eyes.
Other less common causes for raccoon eyes include:
Symptoms caused by and accompanying raccoon eyes include:
- swelling of the eyelids
- tenderness in the area
- Battle’s sign, which is a similar bruising pattern that appears behind the ear
- bruising which appears hours to days after the trauma
- a red eye, or subconjunctival hemorrhage
- sensory changes, such as hearing loss, blurred vision, or reduced sense of smell
- muscular weakness
- high blood pressure and heart rate
In the case of neuroblastoma, raccoon eyes may be accompanied by other symptoms such as:
- fixed and dilated pupils
- red eyes
- bone pain
- eyes failing to move in the same direction
People with amyloidosis may also experience:
- drooping eyelids
- a protruding eyeball
- a growth in the surrounding area
- pain accompanying these symptoms
Doctors will usually diagnose raccoon eyes while looking for the condition causing them. They may perform a physical exam including eye movement tests, nerve tests, and touching the surrounding area.
Imaging tests are the most important part of a diagnosis. They allow doctors to identify the cause of raccoon eyes in a non-invasive way. Doctors will often use a computerized tomography (CT) scan to get a detailed picture of the skull.
Raccoon eyes can lead to complications if left untreated. Traumatic injuries, such as basal skull fractures, can cause significant brain injury, so the person should get tested for any lasting injury caused by the trauma.
Doctors will also monitor people with raccoon eyes for complications such as:
- blood in the eyes
- facial palsy or the inability to control the facial muscles
- bleeding in the brain
- cerebrospinal fluid leaks
- abnormalities in the bones of the skull or face
Doctors will also look for symptoms of post-concussive syndrome, which may include seemingly simple symptoms, such as headaches, ringing in the ears, and fatigue. Sensory changes and insomnia are also signs of post-concussive syndrome.
Raccoon eyes themselves do not often require treatment. Doctors will focus on treating the cause, which should allow the raccoon eyes to go away without any assistance.
In the case of basal skull fractures or craniotomy, treatment may involve surgery. This is especially true if the meninges have been ruptured.
Facial fractures may also be treated with surgery, protective plates, and other devices to repair the injury and prevent further damage.
People with cancers and growths such as neuroblastoma may be given appropriate medical treatment. Treatment for amyloidosis, for example, involves reducing the amount of amyloid in the bloodstream.
Doctors will also treat other complications of raccoon eyes, such as meningitis and aneurysms. Cosmetic surgery may be an option for people who show signs of facial deformity.
Recovery and outlook
Raccoon eyes are a sign of an underlying trauma or condition. Most of the time, this is due to a basal skull fracture or facial fracture. In these cases, the raccoon eyes will go away as the fracture heals.
The outlook and recovery time usually depends on whether any complications arise during the process.
Head injuries such as basal skull fractures are serious and can be fatal, so, anyone experiencing raccoon eyes or has a head injury should contact a doctor immediately for a diagnosis and treatment.
Early diagnosis and treatment help to reduce the chance of lasting damage.