Raccoon Eyes: Symptoms, Causes and Treatment

Raccoon eyes, medically known as periorbital ecchymosis, is a condition characterized by dark discoloration and swelling around the eyes. Although its appearance can be alarming, raccoon eyes are not a disease in themselves but rather a symptom that can stem from a variety of underlying causes—some benign, others quite serious. Understanding the symptoms, potential causes, and available treatments is crucial for timely and effective management, especially since raccoon eyes may signal underlying trauma or systemic disease.

Symptoms of Raccoon Eyes

Raccoon eyes are more than just a cosmetic concern. They reflect underlying processes that cause blood to collect in the tissues surrounding the eyes. While often associated with facial injuries, raccoon eyes can appear in the absence of trauma, making their recognition vital for both patients and healthcare professionals.

Appearance	Accompanying Signs	Severity	Sources
Dark bruising	Swelling, edema	Mild-acute	1 5
Red-purple hue	Pain (sometimes absent)	Varies	1 5
Bilateral or unilateral	Visual disturbances (rare)	Self-limited or persistent	1 5
Periorbital discoloration	Systemic symptoms (in some cases)	May resolve or indicate disease	1 5

Table 1: Key Symptoms

What Do Raccoon Eyes Look Like?

The hallmark of raccoon eyes is the presence of dark, bruise-like rings around one or both eyes. This discoloration is typically red-purple or bluish and may appear suddenly or develop gradually. The term "raccoon eyes" draws its name from the mask-like appearance reminiscent of a raccoon’s facial markings.

• Symmetry: The bruising can be bilateral (affecting both eyes) or unilateral (affecting one eye), depending on the cause.
• Color: Early stages may appear red or purple, fading to greenish-yellow as healing progresses 1.
• Swelling: Puffiness or edema around the eyes is common, though some cases present without swelling or pain 1.

Accompanying Symptoms

While pain and swelling are common, some patients experience raccoon eyes without significant discomfort. Serious visual disturbances are rare, but can occur if the underlying cause affects the eyes directly 1. In some cases—especially those linked to systemic diseases—other symptoms such as fatigue, behavioral changes, headaches, or even neuropsychiatric manifestations may be present 5.

Symptom Variability

The duration and severity of raccoon eyes can vary widely:

• Mild cases: May resolve within days to weeks without intervention 1.
• Severe or persistent cases: May indicate ongoing bleeding, trauma, or underlying disease and can last longer 5.

When to Seek Medical Attention

Although raccoon eyes may sometimes result from minor trauma or even cosmetic procedures, their sudden appearance—especially without a clear cause—should prompt medical evaluation. This is because raccoon eyes can be an early sign of serious conditions like skull fractures, bleeding disorders, or systemic illnesses 1 5.

Causes of Raccoon Eyes

Not all cases of raccoon eyes are caused by a black eye from trauma. The range of potential causes is broad, spanning from minor injuries to serious medical conditions. Understanding these causes is essential for determining the appropriate medical response.

Cause	Mechanism	Commonness	Sources
Skull/facial trauma	Blood tracking to eye area	Frequent	1
Maxillofacial injury	Tissue plane bleeding	Occasional	1
Medical conditions	Vascular leakage	Rare	1 5
Cosmetic procedures	Micro-trauma	Very rare	1
Systemic diseases	Immune/vascular dysfunction	Rare	5

Table 2: Common Causes

Traumatic Causes

Skull and Facial Trauma

The classic association is with fractures of the base of the skull (basilar skull fracture), where blood from the injury tracks along tissue planes to the periorbital (eye) area, causing the characteristic bruising 1. Other forms of trauma—such as severe facial or maxillofacial injuries, thoracic crush injuries, or acute subdural bleeds—can also lead to raccoon eyes via similar mechanisms 1.

Non-Traumatic Causes

Cosmetic Procedures

Surprisingly, even minor, everyday activities such as eyebrow plucking can cause raccoon eyes. This is due to tiny traumas to the delicate skin and blood vessels around the eyebrows, resulting in localized bleeding and discoloration 1. Such cases are very rare and typically self-limited.

Systemic Diseases

A variety of medical conditions can present with raccoon eyes, sometimes as an early or even the initial sign:

• Systemic Lupus Erythematosus (SLE): This autoimmune disease can, in rare cases, cause swelling and bruising around the eyes, sometimes accompanied by neuropsychiatric symptoms 5.
• Cardiac Amyloidosis: Deposition of abnormal proteins in tissues may lead to raccoon eyes, often alongside fatigue, weakness, and enlarged tongue (macroglossia) 1.
• Kaposi’s Sarcoma: A rare cancer that can affect the skin and mucous membranes, sometimes causing periorbital edema and bruising 1.
• Multiple Myeloma: This blood cancer may rarely present initially with raccoon eyes 1.

Other Medical Conditions

• Migraines and Trigeminal Autonomic Cephalalgia: Certain severe headache disorders can cause a range of facial symptoms—including periorbital ecchymosis (raccoon eyes), swelling, tearing, nasal congestion, and even behavioral disturbances 1.
• Bleeding Disorders: Conditions that affect blood clotting can sometimes cause spontaneous bruising, including around the eyes 1.

When Raccoon Eyes Are a Warning Sign

The sudden appearance of raccoon eyes—especially in the absence of trauma or after minor incidents—should always be taken seriously. It can be an early indicator of intracranial bleeding, systemic disease, or other life-threatening conditions 1 5.

Treatment of Raccoon Eyes

Managing raccoon eyes centers on treating the underlying cause rather than the symptom itself. While the bruise-like appearance may resolve on its own, medical intervention may be necessary in more serious cases.

Approach	Goal	Typical Duration	Sources
Observation	Allow natural healing	Days–weeks	1
Treat underlying cause	Address root problem	Variable	5
Medication	Reduce inflammation, immune suppression	Weeks–months	5
Supportive care	Symptom relief	As needed	1 5

Table 3: Treatment Strategies

Observation and Self-Care

For mild cases—such as those following minor trauma or cosmetic procedures—no specific treatment is usually required. The discoloration and swelling typically fade over 1–2 weeks. Applying a cold compress in the first 24–48 hours may help reduce swelling, while warm compresses can aid absorption of the bruise in later stages 1.

Medical Management

Addressing the Underlying Cause

• Trauma: In cases involving head or facial trauma, prompt medical evaluation is critical to rule out skull fractures or internal bleeding. Treatment may include surgery or hospitalization, depending on severity 1.
• Systemic Disease: When raccoon eyes are linked to an underlying medical condition, such as SLE or multiple myeloma, addressing the root cause is essential:
  • SLE: Treatment involves immunosuppressive therapy, such as corticosteroids (e.g., prednisolone) and cytotoxic drugs (e.g., cyclophosphamide), along with supportive medications like hydroxychloroquine. These approaches control inflammation and prevent disease progression 5.
  • Other Conditions: Treatment will vary based on the diagnosis but may involve chemotherapy, immunotherapy, or targeted therapies for cancers or amyloidosis 1.

Monitoring and Follow-Up

In all cases, follow-up is important to ensure that raccoon eyes are resolving and that no further complications arise. For some systemic illnesses, long-term management and monitoring are necessary 1 5.

Supportive Care

Depending on the severity and accompanying symptoms, additional supportive measures may be recommended:

• Pain management: Analgesics for discomfort, if present.
• Protection: Avoiding further trauma to the area.
• Rehabilitation: For patients with neurological or psychological symptoms, multidisciplinary care may be indicated 5.

Conclusion

Raccoon eyes are a striking and sometimes alarming symptom that can stem from a wide variety of causes. Recognizing the signs and seeking timely medical attention, especially when the cause is unclear, is critical for ensuring the best possible outcome.

Key Takeaways:

• Raccoon eyes are characterized by dark, bruise-like discoloration around the eyes, often with swelling 1 5.
• While commonly linked to facial or skull trauma, raccoon eyes can also result from minor injuries, cosmetic procedures, and several systemic diseases 1 5.
• Treatment focuses on the underlying cause; mild cases often resolve on their own, while serious cases may require medication or surgical intervention 1 5.
• Early recognition can be life-saving, especially when raccoon eyes signal hidden trauma or systemic illness.
• Ongoing monitoring and supportive care are important for complete recovery.

Understanding raccoon eyes—from their symptoms and causes to their treatment—empowers individuals and clinicians alike to respond promptly and appropriately to this important clinical sign.