What Causes Black Eye?

Conditions list medically reviewed by George Krucik, MD, MBA

A black eye is the appearance of bruising around the eyes. It’s usually the result of trauma to the head or face, which causes bleeding beneath the skin. When the small blood vessels, or capillaries, beneath the skin break, blood leaks into the... Read More

Overview

A black eye is the appearance of bruising around the eyes. It’s usually the result of trauma to the head or face, which causes bleeding beneath the skin. When the small blood vessels, or capillaries, beneath the skin break, blood leaks into the surrounding tissue. This is what causes the discoloration or bruising.

Most black eyes aren’t serious but can sometimes can be an indicator of a medical emergency such as a skull fracture. Black eye is also referred to as eye bruises and bruising around the eyes.

Black eyes can appear after some surgical procedures, such as nose surgery or a facelift. A black eye may occur when blood, originating in the forehead or nose, settles by gravity under the eye. "Raccoon eyes" refers to blood that settles under the eyes and is associated with a fracture in the base of the skull.

Over the course of a few days, the black and blue color of bruises around the eyes fades to yellow or green. That’s because the blood under the skin eventually breaks down and is reabsorbed into the surrounding tissues. Depending on the amount of blood that has collected within the skin, the tissues may require up to two weeks to return to normal color.

It’s important to be aware that unexplained bruising in someone you know may be a sign of domestic violence or abuse. Your health providers are required by law to ask questions to make sure you’re safe in your domestic situation.

Diagnosis

If you seek medical treatment for a black eye, your doctor will perform a basic examination. They’ll also ask how the injury occurred and inquire about related injuries. Your doctor will test your vision by shining a light into your eyes and will also ask you to follow their finger with your eyes.

If a skull fracture is suspected, you will have a CT scan and X-ray of your face and head. If an eye injury is suspected, you’ll be referred to an ophthalmologist. The specialist may put a dye in your eye to test for eyeball abrasions.

If a head injury is suspected, you will be referred to a neurosurgeon. If fractures of the face are suspected, you’ll be referred to an ENT specialist.

Associated diagnoses

Conditions that are likely associated with a black eye include:

  • broken nose
  • concussion
  • dengue fever
  • hemophilia A
  • hemophilia B
  • epidural hematoma
  • eye emergencies
  • head injury
  • factor II deficiency
  • factor V deficiency
  • factor VII deficiency
  • factor X deficiency
  • shaken baby syndrome
  • skull fracture
  • subdural hematoma
  • von Willebrand disease

Treatment

Black eyes due to a minor injury can be treated with ice, rest, and pain medication. A follow-up visit with your doctor will be suggested if you have any visual changes or lingering pain. If swelling and pain accompany the bruising, apply a cold compress for 20 minutes, then take it off for 20 minutes. When the swelling reduces, you may apply a warm compress to help promote the reabsorption of blood.

For any pain and throbbing, you may take pain relievers such as ibuprofen or acetaminophen. Avoid putting pressure on the affected area.

There are many home remedies you can use to treat a black eye. An ice pack is the best method. Sometimes people use frozen packs of raw meat. It’s best to avoid this, as the meat may contain harmful bacteria.

Arnica is a good herbal remedy to reduce swelling. Another option is to mix 5 tablespoons of melted Vaseline with cayenne pepper to make a natural healing ointment. But careful with this homemade remedy. The ointment can burn the eyeball if the two come in contact. Vitamins C and K will also promote healing and reduce swelling.

Black eye in children and toddlers

Small children will need a cold compress placed on their eye for 15 minutes at a time throughout the day. They may also be required to wear an eye shield because swelling can force the eye shut.

At home, hold your child’s head higher than their heart for a day or two. Try to keep them from being too active. Also, keep your child from rubbing their eye.

When to seek immediate medical treatment

Black eyes are accompanied by an assortment of symptoms that could require medical attention.

A black eye may be the repercussion of a facial fracture. You need to seek immediate medical attention for any broken bones on your face or skull.

If headaches persist or if you experience a loss of vision or consciousness, your black eye may be a symptom of a concussion or a fracture. Other symptoms of a concussion include:

  • nausea
  • vomiting
  • dizziness
  • lethargy
  • memory lapses

Another serious concern is the draining of blood or clear fluid from your nose or ear. Blood on the surface of your eyeball is also a cause for concern. This can be a sign of a ruptured eyeball or of damaged blood vessels in the eye. This may cause additional swelling and infection, which can make your eye immobile and blur your vision.

Complications

Sometimes black eyes can occur without trauma affecting the eye. If you have bad nasal allergies, you can get “allergic shiners.” These shiners may cause dark circles or the appearance of a black eye because blood flow is slightly hindered. The small veins under your eye will pool with blood and enlarge because the blood is going back to your heart more slowly.

Although highly unlikely, a black eye in a child without any sign of trauma can be an early symptom of myeloid leukemia.

Outlook

Most cases of black eye can be treated at home with ice, rest, and pain relievers. A black eye can last anywhere from one to two weeks as the bruising heals and blood slowly is absorbed back into your skin.

Things to avoid while recovering from a black eye are:

  • applying too much pressure
  • putting heat on the affected area
  • playing sports or being overly active in a way that will set you up for further injury

Medically reviewed by Deborah Weatherspoon, PhD, RN, CRNA, COI on November 1, 2016Written by J. C. Jones, MA, RN, and Justin Sarachik


19 possible conditions

This feature is for informational purposes only and should not be used to diagnose. Please consult a healthcare professional if you have health concerns.