Black Eye

Picture of the anatomy of the eye

A black eye often results from injury to the face or the head and is caused when blood and other fluids collect in the space around the eye. Swelling and dark discoloration result in a "black eye" -- sometimes called a "shiner."

Most black eyes are relatively minor injuries. Many heal on their own in a few days, but they may 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, like a bruise (ecchymosis) around the eye.

The skin around the eye is very loose, with mostly fat underneath it, and fluid accumulates easily in this area. The skin around the eye is one of the first places to swell when the facial area is injured. Depending on the location and type of injury, one or both eyes may be affected. Injuries to the eyebrow, nose, and forehead area often result in black eyes because gravity pulls the blood and inflammatory fluid into the soft tissues under and around the eyes.

As a black eye heals, the swelling around the eye decreases, and the bruise gradually fades away. The bruising will usually start a very dark purple, and as it fades, it may change to light purple, then greenish, then yellow before disappearing.

The most common cause of a black eye is a blow to the eye, nose, or forehead. Depending on where the blow lands, one or both eyes may be affected. 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.

Other causes of the black eye include:

• surgical procedures to the face, such as a facelift, jaw surgery, or 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 eyes."

Other causes of swelling around the eye include (these conditions do not necessarily make the skin turn black and blue around the eye):

• allergic reactions,
• bites,
• cellulitis (skin infection around the eye),
• angioedema (swelling, usually around both eyes), and
• dental infections.

Edema (swelling) and pain are the most common signs and symptoms of a black eye and may be accompanied by discoloration caused by the bruising.

Initially, the swelling and discoloration may be mild. The area around the eye often starts slightly reddened and then progresses to a darker shade, and swelling increases. Some blurry vision or difficulty opening the eye may occur, but more serious visual problems are less common. Over a few days, the area becomes lighter and the swelling decreases.

Signs of a more serious injury are double vision, loss of sight, or inability to move the eye. Loss of consciousness, blood or clear fluid coming out of the nose or the ears, blood on the surface of the eye itself, or persistent headache can also indicate a severe injury.

Most black eyes are minor injuries that heal on their own in a few days with ice and OTC pain medications. Depending on the mechanism of injury and accompanying symptoms, an ophthalmologist might have to examine the injured eye to make sure that no significant injury to the eye has occurred.

Call a doctor if the person:

• experiences change in vision;
• has severe pain or swelling that does not go away;
• has swelling around the eyes that is not related to an injury;
• has signs of infection (for example, fever, warmth, redness, pus-like drainage),
• has behavioral changes,
• has forgetfulness or lethargy, or
• nausea, vomiting, and/or dizziness.

Consult a healthcare professional any time you are unsure about treatment or concerned about symptoms.

Some conditions require immediate medical care. Call 9-1-1 or get to an emergency department immediately in the following situations:

• the person experiences changes in or loss of vision (especially double vision);
• an inability to move the eye itself (i.e., unable to look in different directions);
• any injury in which an object may have pierced the eye or may be inside the eyeball;
• if there is obvious blood in the eye itself;
• if there is a deformity to the eye;
• fluid leaking from the eyeball;
• there are any lacerations (cuts) to the eye area, face, or head;
• the person has signs of a serious head or facial injury;
• if the black eye is accompanied by broken bones or teeth;
• loss of consciousness;
• changes in behavior;
• nausea, vomiting, and/or dizziness;
• inability to walk;
• blood or clear fluids coming out of the nose or the ears;
• people who take blood thinners, such as warfarin (Coumadin), or those with a history of bleeding problems such as hemophilia;
• swelling after a bee sting near the eye; or
• from a suspected infection of the eye.

For most black eyes, a doctor will perform a physical exam and will ask about the injury, and look for any associated injuries or symptoms.

The doctor will shine a light into the patient's eyes to look at the pupils and inside the eye itself for any injury and check for foreign bodies or abrasions on the eye. The doctor will test the motion of the patient's eye (following the doctor's finger with the eyes) and examine the facial bones around the eye.

Depending on what the doctor finds, he or she may perform additional testing like an X-ray or a CT scan if the doctor suspects a fracture to the bones of the face or around the eye (the orbit) or if something is inside the eye.

If there are any special concerns, the doctor may refer the patient to a specialist, such as an ophthalmologist (a medical doctor who specializes in eye care and surgery), for follow-up care.

Medical care

For simple, uncomplicated black eyes, the treatment prescribed by healthcare professionals is similar to home treatment:

• ice;
• pain medications such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) (avoid taking aspirin [unless prescribed by your doctor or cardiologist for your heart] because this may increase bleeding);
• rest; and
• protection of the injured area.

Avoid possibly injurious activities until after the eye has healed.

For more complicated injuries, the patient may be referred to an appropriate specialist; such as an ophthalmologist, who can treat the patient's injuries to the eye itself, or an otorhinolaryngologist (ear, nose, and throat [ENT]), or an oral/maxillofacial surgeon for fractures to the face.

Home remedies

Home remedies for the black eye include rest and ice applied early after the injury to decrease swelling and pain.

Ice helps decrease swelling by constricting blood vessels, decreasing fluid accumulation, and cooling and numbing the area.

• Apply ice for 20 minutes every hour for the first 24 hours (a package of frozen vegetables such as peas or corn can be used as it will conform to the shape of the face better than ice cubes).
• To avoid potential cold injury to the site, wrap the ice or frozen object in a cloth or use a commercial ice pack.
• Do not use raw meat on a black eye, as putting potentially bacteria-laden meat on a mucous membrane or an open skin injury can be dangerous.

The black eye in itself usually is a minor condition that resolves on its own. Severe injuries, especially forceful blunt trauma to the eye area may result in complications.

• Traumatic uveitis and iritis (iritis is a type of uveitis) result from blunt trauma to the eye. A black eye may be the first sign of this condition. Iritis generally affects only one eye.
  • Signs and symptoms of uveitis (and iritis) may include:
    • reddened eye (especially around the iris, the colored part of the eyeball);
    • pain that increases with exposure to bright light;
    • a small or irregularly shaped pupil;
    • floating spots before the eyes; or
    • blurred vision.
  • Any of these symptoms should be brought to the attention of a physician.
• Hyphema is an accumulation of blood in the front (anterior) chamber of the eye following injury and can cause damage to the interior tissues of the eye. The amount of blood may be too small to see with the naked eye, or the entire front of the eye may fill with blood.
• Glaucoma may also result from blunt trauma to the eye and can occur immediately or years later. The force of the trauma can cause bleeding inside the eye which leads to an increase in eye pressure and damages the optic nerve. Delayed onset glaucoma (angle recession glaucoma) can occur as scar tissue from the injury builds in the eye.
• Orbital floor fracture (blowout fracture) may also occur as a result of forceful blunt trauma to the eye. The force of the blow pushes the eyeball further into the eye socket, fracturing the very thin walls of bone that make up the eye socket. This can lead to pinching (entrapment) of the optic nerve and the muscles that move the eye. Loss of vision or double vision can result and must be treated emergently.
• Retinal detachment can result in permanent vision loss. Trauma to the eye can lift or pull the retina from its normal position, lining the back of the eyeball. Symptoms include partial or total loss of vision or flashing lights or spots in the field of vision and must be treated immediately.

Black eye injury can be avoided with basic injury prevention.

• Check the home for items that might cause a fall, such as throw rugs or objects on the floor (such as toys).
• Wear the appropriate protective gear for any athletic or work-related activity.
• Wear goggles or other eye protection when working, doing yard work, or participating in other hobbies and sports that may be injurious to the eyes.
• Wear seat belts while driving and wear helmets when riding a motorcycle.