Raccoon Eyes (Periorbital Ecchymosis)

Raccoon Eyes (Periorbital Ecchymosis) Causes:

The following are some of the causes of periorbital ecchymosis. There may be others which have not been mentioned here.

You need to check with your dermatologist or other medical professionals if there is any problem with your skin condition.

1. Excessive sun exposure.

2. UV radiation from the sun.

3. UVA rays from the sun.

4. Melasma caused by excessive use of chemical exfoliants such as glycolic acid, salicylic acid etc.

5. Other environmental factors like pollution, stress, smoking etc.

6. Pesticides such as DDT and organochlorine pesticides (OPCs) such as Dieldrin and Chlordane.

Raccoon Eyes Treatment:

There are several methods of treating raccoon eyes including topical creams, ointments, gels and injections.

1. Carefully clean the skin around the eyes with a sterile cloth or gauze dipped in warm water.

2. Use an antibacterial wash such as Betadine to clean the area.

3. Use a mild steroidal cream such as hydrocortisone to treat the rash.

A clindamycin/benzoyl peroxide combination is also effective against the bacteria and yeast that may be causing the rash.

4. A more aggressive treatment would be to use triamcinolone cream which is a strong steroidal agent.

5. If the problem persists or gets worse, consult a dermatologist who may have to inject the affected areas with steroids such as Kenalog or hydrocortisone.

The injections are not painful.

Unilateral periorbital ecchymosis and Raccoon Eyes:

Periorbital ecchymosis is a condition involving the collection of blood or blood vessels underneath the skin around the eyes. The medical term for it is “peri” which means around and “orbital” which means related to the eyes.

Ecchymosis refers to a collection of purple or red blood underneath the skin, usually the result of trauma. So “unilateral periorbital ecchymosis” means an abnormal collection of blood or blood vessels on only one side of the face.

As you can see from the medical definition a raccoon eye is caused by trauma. The most common causes are physical blows to the face resulting in contusions which may damage the small veins over both eyes, or a fall resulting in bleeding in one area only.

However, it is important to seek medical attention immediately if there is any possibility that a more serious head injury such as a skull fracture may have occurred.

Raccoon eyes are usually not serious but the reasons for them happening should be determined and appropriate treatment started. Many people with raccoon eyes due to physical trauma have no other injuries and will recover fully within a few days.

There is almost always a history of some sort of physical trauma, which has resulted in the raccoon eyes. Falls are a common cause of this condition, but physical assault is another cause that should be considered especially in adults.

If there is any suspicion of physical assault the appropriate authorities need to be notified. There may be other reasons for the injury such as a car accident in which case the standard first aid measures should be followed until medical help arrives.

If you or someone you know and care about has developed a raccoon eye seek immediate medical attention.

Treatment of Unilateral Periorbital Ecchymosis:

1. If there is any bleeding apply constant pressure to the area with a sterile gauze or cloth.

Maintain the pressure at least until the bleeding has stopped, which it should do within a few minutes at most.

2. If the cause is a fall or other accident, seek appropriate medical attention immediately.

3. If the cause is physical assault report it to the police and seek immediate medical attention.

4. If you’ve developed a headache seek immediate medical attention because this may be a symptom of a more serious head injury.

5. If you have any other symptoms such as dizziness, vomiting, confusion, blurred vision, or difficulty walking or standing seek immediate medical attention.

Sources & references used in this article:

Periorbital ecchymosis (‘raccoon eyes’) as the presenting feature of neuroblastoma by DE Moran, V Donoghue – Pediatric radiology, 2010 – Springer

A child with raccoon eyes masquerading as trauma by K Gumus – International ophthalmology, 2007 – Springer

Raccoon eyes by RA McPheeters, S White, A Winter – Western Journal of …, 2010 – escholarship.org

Recurrent bilateral periorbital and circumoral bruising due to vomiting by AIS Hussain – Case Reports, 2014 – casereports.bmj.com

The clinical features of periorbital ecchymosis in a series of trauma patients by A Somasundaram, AW Laxton, RG Perrin – Injury, 2014 – Elsevier

Raccoon eyes and neuroblastoma by R Timmerman – New England Journal of Medicine, 2003 – Mass Medical Soc

Periorbital ecchymosis–trauma or tumor? by I Dober, E Stranzinger, CJ Kellenberger, TA Huisman – Praxis, 2007 – europepmc.org

Periorbital ecchymosis (raccoon eye) and orbital hematoma following endoscopic retrograde Cholangiopancreatography by J Nasiri, F Zamani – Case reports in gastroenterology, 2017 – karger.com

A 64-year-old woman with raccoon eyes following kidney biopsy: a case report by S Mei, Y Zhao, L Li, C Mei, B Dai – BMC nephrology, 2020 – Springer