Black Eye

It takes about two weeks for a black eye to heal.

A black eye is a relatively common result of injury to the face or the head, 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 heal in a few days, however, 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.

• The skin around the eye is very loose, with mostly fat underneath, making 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, forehead, or nose. Depending on where the blow lands, one or both eyes may be affected. Other causes of a black eye are:

• 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, and
• nose surgery.
• 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,
  • insect bites,
  • cellulitis (skin infection around the eye),
  • angioedema (a 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, swelling, and bruising are the most common signs and symptoms of a black eye.

• Initially, the swelling and discoloration may be mild. The eye may start off slightly reddened, then progress to a darker shade.
• Later, 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 decreases.

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

A 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
• A persistent headache

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

Call your doctor if these conditions develop with a black eye:

1. Changes in vision
2. Severe pain continues
3. The swelling is not related to an injury
4. Signs of infection (for example, warmth, redness, pus-like drainage).
5. You are unsure about treatment or concerned about symptoms.
6. Swelling does not start to improve after a few days.

Seek immediate medical care for these conditions:

1. Changes in or loss of vision, especially double vision
2. Inability to move the eye (for example, unable to look in different directions)
3. Any injury in which you think an object pierced the eye or may be inside the eyeball
4. Obvious blood in the eye
5. Deformity to the eye or fluid leaking from the eyeball
6. 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:

1. Broken bones
2. Broken teeth
3. Loss of consciousness (knocked out)
4. Nausea, vomiting, and/or dizziness after the injury
5. Behavioral changes, forgetfulness, or lethargy
6. Inability to walk after the injury
7. Blood or clear fluids from the nose or the ears
8. Lacerations to the face or the head
9. Any signs of infection, such as fever

People who take blood thinners, (for example, warfarin [Coumadin, Jantoven]), or those with a history of bleeding problems such as hemophilia, should 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 be evaluated by a doctor.

For most black eyes, a basic physical examination is all that is required. The doctor asks about the facts in regard to the injury and looks for associated injuries or symptoms.

The basic physical examination includes checking the patient's vision, shining a light into the eyes to look at the pupils and inside the eye itself for any injury, testing the motion of the eye (following the doctor's finger with the eyes), and examining the facial bones around the 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 or foreign bodies (objects).
• If the doctor suspects the patient may have a fracture to the bones of the face or around the eye (the orbit), an X-ray or a CT scan may be ordered. 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 the patient to an appropriate specialist, such as an ophthalmologist (a medical doctor who specializes in eye care and surgery), for follow-up care.

Most cases of a black eye can be cared for at home with over-the-counter (OTC) pain medication, ice, and rest. Seek medical care if the eye becomes infected or does not heal within two weeks.

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

Ice helps 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. Do not apply ice 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. Avoid athletic or other possibly injurious activities until the eye has healed.

Do not put a steak or a piece of raw meat on a black eye. Putting potentially bacteria-laden meat on a mucous membrane or an open skin injury can be dangerous.

For simple, uncomplicated black eyes, the treatment prescribed is similar to home treatment: ice, over-the-counter pain medications (avoid aspirin-unless prescribed by a doctor or cardiologist for a heart condition - because this may increase bleeding), rest, and protection of the injured area.

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

• A neurosurgeon for injuries to the skull or the brain
• An ophthalmologist for injuries to the eye itself
• An otorhinolaryngologist [ear, nose, and throat (ENT)] for fractures to the face
• An oral/maxillofacial surgeon for fractures to the face
• A plastic surgeon to repair serious cuts to the face

For more complicated injuries, follow-up with the specialist the doctor has recommended. Keep these appointments, and closely follow the instructions of the specialist. Contact the doctor immediately if the you experience any changes or worsening of symptoms.

• For most people, black eyes heal in one to two 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 the patient.

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 the elderly and children.
• Wear appropriate protective gear for any athletic or work-related activity to help protect against not only black eyes but also other serious injuries.
• Wear goggles or other eye protection when working, doing yard work, or other hobbies and sports to help prevent all types of eye injuries.
• Wear seat belts while driving and wear helmets when riding a motorcycle or bicycle.