OPHTHALMOLOGY

Gregory Eippert, MD

Q: When is a black eye of serious concern? A: A black eye, periorbital hematoma, is a bruising around the eye due to facial injury rather than eye injury. This bruising and the subsequent discoloring of the skin is caused by broken blood vessels under the skin and is a collection of blood (hematoma) located in the tissues around, not inside, the eye (periorbital). Most black eyes are not serious and usually resolve in a week or two.

Black eyes are usually the result of blunt force or trauma to the face or eye area sustained while playing sports, working, after walking into something, from the impact of a fall, or as a result of impact during a car accident. Other causes may include a blow to the head or other head trauma, sinus infections, nasal surgery, dental work, or cosmetic eye surgery.

To help minimize the pain and reduce the swelling of a black eye, apply an ice pack to the eye for 15-20 minutes at a time, once every hour as needed. The coldness causes the blood vessels around the eye to constrict which slows bleeding underneath the skin that causes the appearance of the black eye. In lieu of an ice pack, a bag of frozen vegetables will suffice. Be careful to avoid freezing the skin and wrap the ice pack or bag of vegetables in a cloth if needed. A black eye is as uncomfortable as it looks. For pain management, take Tylenol or Ibuprofen and avoid aspirin which is a blood thinner and could cause the eye to appear worse. As much as possible, keep the head elevated until the black eye heals to help keep excess blood flow away from the injury. This in turn will help reduce swelling and intraocular pressure more quickly and speed up the healing process.

Unless the eye itself has been injured, a black eye will heal on its own. If the eye is injured however, certain symptoms indicate that you should see an eye doctor: bleeding inside the eye, any changes in vision, dizziness, loss of consciousness, vomiting, severe pain, inability to move the eye, unequal pupils, bruising around both eyes, no signs of healing after a week or not completely healed in three weeks, persistent headaches, or signs of infection such as warm to the touch, redness, pus, or fever.

In general, medical treatment for black eye is likely not necessary. Given a week or two, the swelling will go down and the bruised skin will turn from blue-black to yellowish brown and then back to your natural skin tone.