Black Eye

A black eye is a relatively common result of some injury to the face or the head. A black eye is caused when blood and other fluids collect in the space around the eye. Swelling and dark discoloration result—hence, the name "black eye."

Most black eyes are relatively minor injuries. Many black eyes heal on their own in a few days. Sometimes, they signify a more serious injury.

Despite the name, "black eye," the eye itself is not usually injured. The tissues around the eye may be significantly discolored and swollen without any injury to the eye itself. Think of it as a bruise around the eye.

Like a bruise, as a black eye heals, the swelling around the eye decreases, and the bruise gradually fades away.

• The skin around the eye is very loose, with mostly fat underneath it. This makes it an ideal site for fluid to accumulate. The effects of gravity also help to swell this part of the face. This is why many people wake up with "puffy" eyes in the morning.

• When there is an injury to the face, the skin around the eye is one of the first places to swell. Depending on the location and type of injury, one or both eyes may be affected.

The most common cause of a black eye is a blow to the eye or the nose. Depending on where the blow lands, one or both eyes may be affected.

• A blow to the nose often causes both eyes to swell because the swelling from the nasal injury causes fluid to collect in the loose tissues of the eyelids.

• Surgical procedures to the face, such as a facelift, jaw surgery, or nose surgery, can cause black eyes as well.

• A certain type of head injury, called a basilar skull fracture, causes both eyes to swell and blacken. This condition is typically described as "raccoon’s eyes."

• Other causes of swelling around the eye include allergic reactions, bites, cellulitis (skin infection around the eye), angioedema (hereditary condition causing swelling, usually around both eyes), and dental infections. However, these conditions do not make the skin turn black and blue around the eye.

• Pain and swelling are the most common signs and symptoms of a black eye.
  
  
  • Initially, the swelling and discoloration may be mild. The eye often starts off slightly reddened, then progresses to a darker shade.
    
    
  • Ultimately, the skin around the eye becomes deep violet, yellow, green, or black in color.
    
    
  • Swelling increases as discoloration progresses.
    
    
  • Over the course of a few days, the area becomes lighter and the swelling goes down.

• Although some blurry vision or difficulty opening the eye may be seen because of the swelling, more serious visual problems are less common.

• Headache may also be present, because the usual cause of a black eye is some sort of head injury.

• Signs of a more serious injury are:
  
  
  • Double vision
    
    
  • Loss of sight
    
    
  • Loss of consciousness
    
    
  • Inability to move the eye
    
    
  • Blood or clear fluid from the nose or the ears
    
    
  • Blood on the surface of the eye itself
    
    
  • Persistent headache

Most black eyes are minor injuries that heal on their own in a few days with ice and pain medications. An ophthalmologist should examine the injured eye to make sure that no significant injury to the eye has occurred. 

• Call your doctor if these conditions develop with a black eye:
  
  
  • You have changes in vision.
    
    
  • Severe pain continues.
    
    
  • The swelling is not related to an injury.
    
    
  • You have signs of infection (eg, warmth, redness, puslike drainage).
    
    
  • You are unsure about treatment or concerned about symptoms.
    
    
  • You have behavioral changes.
    
    
  • Swelling does not start to improve after a few days.
  
  
• Seek immediate medical care for these conditions:
  
  
  • Changes in or loss of vision
    
    
  • Inability to move the eye itself (ie, unable to look in different directions)
    
    
  • Any injury in which you think an object pierced the eye or may be inside the eyeball
    
    
  • Obvious blood in the eye itself
    
    
  • Deformity to the eye or fluid leaking from the eyeball
    
    
  • Any lacerations (cuts) to the eye area
  
  
• Go to a hospital's emergency department if you have signs of a serious head or facial injury:
  
  
  • Broken bones
    
    
  • Broken teeth
    
    
  • Loss of consciousness (knocked out)
    
    
  • Change in behavior after the injury
    
    
  • Vomiting after the injury
    
    
  • Inability to walk after the injury
    
    
  • Blood or clear fluids from the nose or the ears
    
    
  • Lacerations to the face or the head
    
    
  
  
• People who take blood thinners, such as warfarin (Coumadin), or those with a history of bleeding problems, such as hemophilia, should also go to a hospital's emergency department.
  
  
• Swelling either after a bee sting near the eye or from a suspected infection of the eye should also be evaluated by a doctor.

|Questions to Ask the Doctor|

• Is there any damage to the eye itself?
  
  
• Are there any fractures of the bone around the eye?

For most black eyes, a basic physical examination is all that is required.

• The doctor asks about the facts regarding the injury and looks for any associated injuries or symptoms.
  
  
• The basic physical examination includes checking your vision, shining a light into your eyes to look at the pupils and inside the eye itself for any injury, testing the motion of your eye (following the doctor’s finger with your eyes), and examining the facial bones around your eye.
  
  
• Depending on what is found, the doctor may perform additional testing.
  
  
  • The doctor may put a dye on the eye and look at the eye under a special light to check for abrasions to the eyeball.
    
    
  • If the doctor suspects you may have a fracture to the bones of the face or around the eye (the orbit), you may have an x-ray or a CT scan. This may also be done if the doctor suspects that something is inside the eye.
    
    
  • If there are any special concerns, the doctor will refer you to an appropriate specialist, such as an ophthalmologist (a medical doctor who specializes in eye care and surgery), for follow-up care.
  
  

|Self-Care at Home|

Rest and ice applied early after the injury help to decrease swelling and pain.

• Ice helps to decrease swelling by constricting blood vessels, by decreasing fluid accumulation, and by cooling and numbing the area.

• Apply ice for 20 minutes an hour every hour while awake, for the first 24 hours. Ice should not be applied directly to the injury.
  
  
• To avoid potential cold injury to the site, wrap the ice in a cloth or use a commercial ice pack. A bag of frozen vegetables wrapped in a cloth makes a good ice pack.

• Protect the area from further injury. Stay away from athletic or other possibly injurious activities until after the eye has healed.

• Forget the old adage about putting a steak or a piece of raw meat on a black eye. No scientific evidence supports this claim. In addition, there is a danger in putting potentially bacteria-laden meat on a mucous membrane or an open skin injury.

|Medical Treatment|

For simple, uncomplicated black eyes, the treatment prescribed is similar to home treatment: ice, pain medications (avoid aspirin because this may increase bleeding), rest, and protection of the injured area.

For more complicated injuries, you may be referred to an appropriate specialist:

• Neurosurgeon for injuries to the skull or the brain
  
  
• Ophthalmologist for injuries to the eye itself
  
  
• Otorhinolaryngologist (ear, nose, and throat [ENT]) for fractures to the face
  
  
• Plastic surgeon to repair serious cuts to the face

|Follow-up|

For simple black eyes, follow up as needed or as directed by your doctor.

For more complicated injuries, follow up with the specialist that your doctor has recommended. Make and keep these appointments, and closely follow the instructions of your specialist.

Contact your doctor immediately if you experience any change in or worsening of your symptoms.

|Prevention|

Avoid a black eye with basic injury prevention.

• Check your home for items that might cause a fall, such as throw rugs or objects on the floor. This will decrease injuries for both older people and younger people.

• Wear the appropriate protective gear for any athletic or work-related activity. This will help protect you against not only black eyes but also other serious injuries.

• Wear goggles or other eye protection when working or doing yard work or other hobbies. You will help prevent all types of eye injuries.

• Wear seat belts while driving and wear helmets when riding a motorcycle.

|Outlook|

For most people, black eyes heal in 1-2 weeks. Use of ice in the first 24 hours after the injury has the most significant effect on the speed with which the injury heals.

For more complicated eye injuries, the prognosis depends on the severity and complexity of the injury. Discuss these injuries with the specialist who treats you.

American Academy of Ophthalmology
655 Beach Street
Box 7424
San Francisco, CA 94120
(415) 561-8500

|Web Links|

MedlinePlus, Black Eye

American Academy of Ophthalmology

shiner, punched in the eye, eye injury, eye injuries, contusion, basilar skull fracture, bruise, blow to the eye, ecchymosis, black eye

Author: Gerald E Maloney, Jr, DO, Attending Physician, Clinical Instructor of Emergency Medicine, Department of Emergency Medicine, John Stroger Hospital of Cook County.

Coauthor(s): William R Fraser, DO, Associate Clinical Professor, Department of Emergency Medicine, Ohio University College of Osteopathic Medicine; Program Director, Department of Emergency Medicine, Doctors Hospital.

Editors: Richard W Allinson, MD, Associate Professor, Division of Ophthalmology, Texas A&M University Health Science Center, Associate Professor, Department of Surgery, Scott and White Clinic; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, ; Robert H Graham, MD, Ophthalmologist, Robert H Graham, MD, PC; Affiliated With Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona and Carl T Hayden VA Medical Center, Phoenix, Arizona.