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Raccoon Eyes – Causes, Symptoms & Treatment
Raccoon eyes describe bilateral bruising around both eye sockets, a classic clinical sign of a basal skull fracture that requires immediate medical evaluation.
Add as Preferred SourceThings worth knowing about "Raccoon eyes"
Raccoon eyes describe bilateral bruising around both eye sockets, a classic clinical sign of a basal skull fracture that requires immediate medical evaluation.
What Are Raccoon Eyes?
Raccoon eyes (also called periorbital hematoma or bilateral periorbital ecchymosis) refer to the distinctive bilateral bruising that appears around both eye sockets, giving the patient a raccoon-like appearance. The discoloration results from blood that has tracked through tissue planes into the loose connective tissue surrounding the eyes. When bruising occurs around only one eye, it is referred to as a monocle hematoma.
Causes
Raccoon eyes are typically a clinical warning sign rather than an isolated finding. The most common causes include:
- Basal skull fracture: A fracture of the base of the skull is the most important and classic cause. Blood from the fracture site travels along fascial planes and pools around the orbits.
- Severe traumatic brain injury (TBI): Significant head trauma can cause vascular injuries leading to extensive hemorrhage spreading to the periorbital region.
- Neuroblastoma: Particularly in children, metastatic spread of neuroblastoma to the orbital region can produce bilateral periorbital bruising without prior trauma.
- Coagulopathies: Bleeding disorders or anticoagulant medications can predispose patients to widespread bruising including the periorbital area.
Symptoms and Associated Signs
Raccoon eyes present as a visible blue-purple to dark red discoloration of both eyelids and the surrounding skin. They are often accompanied by other signs indicating a basal skull fracture:
- Battle's sign: Bruising over the mastoid process behind the ear
- CSF rhinorrhea or otorrhea: Leakage of cerebrospinal fluid from the nose or ear
- Tinnitus or hearing loss
- Loss of consciousness or confusion
- Visual disturbances or double vision (diplopia)
Diagnosis
The diagnosis of raccoon eyes is primarily clinical, based on the characteristic appearance. However, because this sign may indicate a serious underlying injury, further investigations are essential:
- CT scan of the skull and brain: The gold standard for identifying basal skull fractures, intracranial hemorrhage, and brain injuries.
- MRI: Used as a complement to CT to assess soft tissue injuries and subtle brain lesions.
- Neurological examination: Assessment of consciousness, reflexes, and cranial nerve function.
- Laboratory tests: Complete blood count and coagulation studies to rule out bleeding disorders.
Treatment
Treatment is directed entirely at the underlying cause. Raccoon eyes themselves are a symptom and do not require specific local therapy.
- Basal skull fracture: Immediate hospital admission, monitoring in an intensive care or neurosurgical unit, and neurosurgical consultation for complications such as intracranial hemorrhage or CSF leakage.
- Conservative management: Many basal skull fractures heal with strict monitoring, bed rest, pain management, and close neurological observation.
- Surgical intervention: Required in cases of persistent CSF fistula, severe nerve damage, or significant intracranial bleeding.
- Neuroblastoma: Oncological treatment including chemotherapy, radiotherapy, or surgery depending on tumor stage.
When to Seek Medical Attention
Raccoon eyes are always a medical emergency. Bilateral periorbital bruising following trauma or a head injury requires immediate emergency evaluation. Even without a known traumatic event, the cause must be urgently investigated. Call emergency services (911 or the local emergency number) without delay.
References
- Winn, H. R. (Ed.) (2011). Youmans Neurological Surgery (6th ed.). Elsevier Saunders. Chapter on Skull Base Fractures.
- Rickels, E. et al. (2006). Guidelines for the Management of Traumatic Brain Injury in Adults. German Society of Neurosurgery (DGNC). Available at: www.awmf.org
- Pommersheim, W. et al. (2003). Basal skull fractures: a modern view. Radiology, 229(3), 685-699. PubMed PMID: 14657306.
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