BLACK EYE

A ”black eye” is a bruise to the eyelid skin caused by blunt trauma to the eye region. Like many bruises, a “shiner” may be nothing to worry about and might disappear on its own in a few days.

In some cases, however, a black eye is a warning sign of more serious injury to the eye or to the skull. Any damage to the eyeball that causes it to become red and swollen must be promptly evaluated by a doctor or an eye specialist. Blunt force eye injuries, as happens in fighting, competitive sports, and ordinary accidents, could involve an unsuspected detached retina, internal bleeding, or other serious problems. A fracture involving the delicate bones around the eye may trap an eye muscle or soft tissues. An orbital fracture could damage the optic nerve and permanently damage eyesight. If so, emergency surgery may be required to correct the condition.

Causes

Most black eyes are the result of blunt trauma that causes bleeding beneath the thin eyelid skin, producing the characteristic black and blue discoloration. A fracture deep inside the skull can also blacken both eyes, even though the eye area itself was not injured. People with sinusitis from allergies sometimes get “allergic shiners” — darkening under the eyes caused by inflamed and engorged blood vessels.

  • A black eye often results from injury to the face or the head, and is caused when blood and other fluids collect in the space around the eye. Swelling and dark discoloration result in a “black eye.”
  • Most black eyes are relatively minor injuries. Many heal on their own in a few days, but they may signify a more serious injury.
  • The most common cause of a black eye is a blow to the eye, nose, or forehead.
  • Pain and swelling are the most common signs and symptoms of a black eye.
  • Call a doctor if the injured individual has changes in vision, severe pain, or swelling that does not go away, the swelling around the eyes is not related to an injury, there are signs of infection (for example, fever, warmth, redness, pus-like drainage), if the person has behavioral changes, forgetfulness or lethargy, nausea, vomiting and/or dizziness, loss of vision (especially double vision), or an inability to move the eye itself (i.e., unable to look in different directions).
  • Home remedies for black eye include rest and ice applied early after the injury help to decrease swelling and pain. Do not use raw meat on an eye injury, this creates potential for infection.
  • Avoid a black eye with basic injury prevention. Wear the appropriate protective gear for any athletic or work-related activity.
  • Complications include traumatic iritis and uveitis, hyphema, glaucoma, orbital floor fracture (blowout fracture), and retinal detachment.

The signs of a black eye include bruising and swelling of the eyelid and soft tissue around the injured eye, sometimes accompanied by broken blood vessels along the white of the eye, called a subconjunctival hemorrhage.

The discoloration starts out deep purple or blue, then may turn green or yellow before disappearing, usually in about a week.

First aid

  • Apply ice to the area. Don’t press on the eye.
  • For pain, give acetaminophen (Tylenol). Don’t give aspirin or ibuprofen (Advil, Motrin), because they can increase bleeding.

When to see a doctor

  • There was loss of consciousness as a result of the injury.
  • Black eyes appear affecting one or both eyes after a head injury; you should be examined by a doctor for possible skull fracture.
  • You have blurry or double vision.
  • You can’t move your eyeball in a certain direction.

Any of the symptoms below may indicate damage to the eyeball, which should be evaluated and treated by an eye care specialist:

  • Your eyeball hurts
  • You have an open cut around the eye
  • You have blurred vision, or see multiple images or floating spots
  • You see blood or other abnormalities within the white or colored parts of the eye
  • You experience unusual sensitivity to light or other vision changes

For most black eyes, a doctor will perform a physical exam and will ask about the injury and look for any associated injuries or symptoms.

The physician will shine a light into the patient’s eyes to look at the pupils and inside the eye itself for any injury, and to check for foreign bodies or abrasions on the eye. They will test the motion of the patient’s eye (following the doctor’s finger with his/her eyes), and examine the facial bones around the eye.

Depending on what is found, the doctor may perform additional testing. An X-ray or a CT scan may be performed if the doctor suspects a fracture to the bones of the face or around the eye (the orbit) or that something is inside the eye.

If there are any special concerns, the doctor may refer the patient to a specialist, such as an ophthalmologist (a medical doctor who specializes in eye care and surgery), for follow-up care.

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