Raccoon Eyes – Healthnile.com

Raccoon eyes are dark bruises that form around both eyes, often with swelling. Bleeding under the skin collects in the soft tissue around the eyes, most often after a skull or facial fracture. This symptom can signal a serious injury inside the head, even if there is no pain in the eyes themselves.

Accidents and head trauma most commonly cause raccoon eyes, but they can also develop after certain surgeries, some cancers, or other conditions that cause internal bleeding. The discoloration does not appear right away—it can take hours or even a day after the injury for the bruising to show.

Definition of Symptom

Raccoon eyes refers to dark bruising around one or both eyes. The discoloration often appears as purple, blue, or dark brown patches, resembling the markings around a raccoon’s eyes.

This symptom is also called periorbital ecchymosis or the raccoon sign. It is different from dark circles caused by tiredness or allergies. Instead, it usually results from bleeding under the skin around the eyes.

Bruising forms when small blood vessels break and leak blood into the soft tissue, often after head or facial injuries. In some cases, it signals a basilar skull fracture, which is a break in the bone at the base of the skull. Key features include:

Location: Upper and lower eyelids.
Color changes: Dark purple, blue, or brown.
Onset: May appear hours or days after injury.
Pain: Can be present but is not always severe.

Term	Meaning
Raccoon eyes	Bruising around both eyes from internal bleeding.
Periorbital ecchymosis	Medical name for raccoon eyes.
Raccoon sign	Another name for the same symptom.

Raccoon eyes can appear on one side or both sides of the face. When they appear on both sides, it often points to a more serious cause.

Possible Causes/Diseases Condition

Raccoon eyes, also called periorbital ecchymosis, can result from several conditions. Blood collects under the skin around the eyes due to injury or illness.

Common Causes

Basilar Skull Fracture: Head trauma can cause bleeding from the fracture that moves to the eye area.
Facial Fractures: Broken nose, cheekbones, or orbital bones can cause bruising around the eyes.
Brain Injury: Head trauma may damage blood vessels and lead to discoloration.

Some non-traumatic causes are also possible. Conditions that affect blood clotting, such as certain cancers or bleeding disorders, may cause similar bruising. Rarely, severe coughing, sneezing, or straining can break small blood vessels near the eyes.

Condition	How it may cause raccoon eyes
Neuroblastoma	Cancer that can spread to the area around the eyes.
Lymphoma	May affect blood vessels and cause bruising.
Thoracic Trauma	Chest injuries can sometimes lead to facial bruising.
High Blood Pressure	May increase risk of vessel damage and bleeding under the skin.

Other Non-Disease Causes

Not all cases of raccoon eyes come from illness. Some happen due to physical events or activities that affect the face or head. These causes usually involve minor trauma or pressure changes rather than medical conditions. Common non-disease causes include:

Facial injuries such as a broken nose or cheekbone.
Orbital fractures from sports or accidents.
Minor periorbital trauma like eyebrow plucking.
Vigorous sneezing or coughing that bursts small blood vessels.
Post-surgical effects after certain head or facial procedures.

Sports, falls, or accidents can break small blood vessels around the eyes and cause bruising that looks like raccoon eyes, even without a skull fracture. Pressure changes in the head, such as those from forceful coughing or sneezing, can also cause temporary discoloration by breaking fragile blood vessels under the skin.

Some cosmetic or medical procedures near the eyes may leave temporary bruising. For example, eyebrow shaping or certain injections can cause mild swelling and discoloration in the area.

Cause	How It Happens	Typical Duration
Minor trauma	Impact to face or eye area	Days to 2 weeks
Pressure changes	Sneezing, coughing, straining	Few days
Cosmetic procedures	Hair removal, injections	Few days

These causes are usually short-term and resolve as the bruising heals. However, if the discoloration appears without a clear reason, medical evaluation is recommended.

How It Causes the Symptom

Raccoon eyes happen when blood collects under the skin around the eyes. Injured blood vessels, usually after trauma to the head or face, cause this bleeding. A basilar skull fracture often causes raccoon eyes. When the bone at the base of the skull breaks, small blood vessels tear and leak blood into the soft tissues near the eyes.

Other injuries or medical procedures, such as facial fractures, brain surgery, or certain bleeding disorders, can also damage capillaries and allow blood to pool under the skin. Common causes linked to raccoon eyes:

Head trauma from accidents or falls
Facial bone fractures
Surgical procedures involving the skull or brain
Rarely, cancers that affect the skull or blood vessels

The dark color around the eyes appears because the blood under the skin changes as it breaks down. This discoloration often develops hours after the injury, not immediately. In some cases, raccoon eyes appear on both sides (bilateral). This pattern is often a strong sign of a basilar skull fracture.

Cause Type	How It Leads to Raccoon Eyes
Skull fracture	Tears vessels at skull base
Facial fracture	Damages vessels near eyes
Surgery	Disrupts blood vessels
Blood disorders	Increases bleeding risk

Possible Complications

Raccoon eyes often signal bleeding under the skin around the eyes. If the cause is not treated, complications can develop depending on the underlying injury or condition. Potential issues include:

Infection if an open wound or surgical site is involved.
Vision changes from swelling or pressure near the eyes.
Persistent swelling or discoloration if healing is delayed.
Nerve damage affecting facial sensation or movement.

In cases linked to a basilar skull fracture, cerebrospinal fluid (CSF) can leak, raising the risk of meningitis, a serious infection of the brain and spinal cord lining. Untreated head injuries can also lead to long-term problems, such as headaches, dizziness, or memory issues. These may appear days or weeks after the injury.

If raccoon eyes are related to a bleeding disorder, ongoing internal bleeding may occur. This can cause anemia or other complications if not addressed promptly. When to seek urgent care:

Symptom	Possible Concern
Clear fluid from nose or ears	CSF leak
Severe headache	Brain injury
Double vision	Nerve or muscle damage
Fever with swelling	Infection

When to Seek Medical Attention

Raccoon eyes can signal a serious injury, especially if they appear after a head or facial trauma. In these cases, seek medical care immediately to rule out skull fractures or internal bleeding.

If the cause is unknown and not related to minor factors like lack of sleep or makeup, have a doctor check the condition. Seek urgent medical attention if raccoon eyes come with:

Severe or worsening headache
Nausea or vomiting
Confusion or disorientation
Changes in vision
Loss of consciousness

Sometimes, raccoon eyes link to conditions like air trapped inside the skull or other internal injuries. Doctors may use imaging tests, like a CT scan, to find the cause. Key situations to act quickly:

Situation	Action
After head injury	Go to the emergency department
New unexplained bruising around both eyes	Schedule prompt medical evaluation
Symptoms worsening over hours or days	Seek urgent care

Even mild pain with raccoon eyes may signal bleeding under the skin from broken blood vessels. A healthcare provider can check if you need treatment and help prevent complications.