A black eye refers to bleeding in the area of the eyelid or eye socket. It can occur due to a fall, accident, as a result of surgery, or in association with certain medical conditions.
What is a black eye?
The so-called hematoma or bruise occurs when blood vessels in and under the individual layers of the skin, the muscles or the blood supply to the bones of the face and skull are ruptured or destroyed and describes the visible bleeding into the surrounding tissue directly in and under the skin. This demands space and thus, depending on the extent, brings with it various symptoms, such as the typical discoloration of the area, edema formation and pain. Localization to the lower or upper eyelid or in and around the orbits is also of importance here.
Causes
Causes include trivial falls or accidents, which result in injuries in the area of the eyes. Blows to the eye, temple, forehead, or jaw can also be associated with such hemorrhages, as the area of the eye is supplied with many fine capillary vessels. Patients who regularly have to take antidepressants or blood-thinning drugs such as Marcumar or Xarelto are particularly at risk in these situations. The blood often fills the area of the bags under the eyes very quickly and forms enormous edemas and effusions below the eye. Various diseases can also bring hematomas. A monocular or spectacle hematoma describes a ring-like appearance of the effusion around one or both eyes. The term spectacle hematoma describes a symptom pattern that affects both eyes. If here is no injury to the eyes or the immediate surrounding structures, it is often an indication of a skull base fracture or even a tumor formation in the brain. In this case, a doctor should be consulted in any case, who will undertake further diagnostics. Operations such as laser surgery for cataracts, an increasing clouding of the lens of the eye, which is replaced by an artificial lens in the course of the operation, can also result in a hematoma often localized to the lower eyelid.
Symptoms, complaints, and signs
A black eye usually results from external force, so that the usual discoloration occurs. Such discoloration is probably also the most common sign of an existing black eye. Often burst blood vessels indicate a black eye, which are clearly visible on the white eyeball. Increased lacrimation is also a symptom that is very commonly associated with a black eye. Of course, not only external manifestations occur with a black eye. Even a slight feeling of pressure in the area of the black eye can cause severe pain. Swelling around the eye is also possible and is a clear indication of an impending black eye. The swelling can increase over time and the pain often becomes more severe as well. However, permanent cooling of the affected area can effectively counteract this complaint. Complaints such as severe swelling, a constant feeling of pressure and headaches are also not uncommon. Nevertheless, a black eye is not a clinical picture that must be treated by a doctor. Provided that there is no fracture, medical treatment is not necessary.
Diagnosis and course
After a blow to the face without an open wound, redness usually appears, indicating the contusion and injury of the tissue and capillaries located there. Later, edema develops, lymphatic fluid enters the tissue. The hemorrhage usually becomes visible only after several hours. In this case, there is necessarily a vascular injury. Diagnosis is made by inspection and palpation in lateral comparison. This provides information about the extent of the tissue change. In the case of complicated injuries and fractures, the bony structure can be clarified by the physician via X-ray and CT, and the soft tissue situation via ultrasound and MRI. The course of the disease now consists primarily in the healing of the injured vessels and the removal of clotted blood particles and stored lymphatic fluid back into the systemic circulation. It takes about 14 days for the skin to return to normal color. The coloration of the effusion indicates both the extent of injury and the progress of healing through red to blue and green/yellow. Blood clotting begins at the blue coloration stage.The following color changes result from the composition of blood components still present in the affected area and the breakdown of hemoglobin.
Complications
In most cases, a black eye is harmless; however, sometimes it can lead to complications. First, the bruise may cause various accompanying symptoms, such as headache or dizziness. If the bruise does not heal on its own, there is a risk of inflammation or encapsulation of the injured tissue. Rarely, such inflammation can lead to life-threatening bleeding in the area of the brain. An increased risk exists for patients who suffer from hemophilia or who regularly take blood-thinning medication. If a concussion is added to the black eye, impaired consciousness, feelings of weakness and nausea may occur, among other symptoms. If there is bloody discharge from the ears, mouth or nose, there may be a skull base fracture, which is life-threatening if left untreated. Complications are rare in the treatment of black eye; treatment with cooling compresses, for example, may cause hypothermia of the affected region, and familiar home remedies such as chili or petroleum jelly may further irritate the sensitive region around the eyes if used incorrectly. To rule out any complications, a black eye should always be clarified by a doctor.
When should you see a doctor?
A black eye is usually caused by external force, so there may be discoloration around the eye. At the same time, this condition is also associated with pain, especially if significant pressure is applied to the affected region. Within three to four days, however, a black eye should heal or the swelling and discoloration should subside. Any existing pain should also slowly subside. If there is no clear improvement after the mentioned period of time, then a doctor should definitely be consulted. In many cases, pus formation occurs in addition to the black eye. In such a case, if not treated, it can even lead to an abscess. Of course, even in the case of an abscess, treatment by a doctor is necessary. This is the only way to ensure rapid healing and recovery. Therefore, if there is no clear improvement in a black eye after three to four days, a doctor should be consulted as soon as possible. Only through a professional examination can serious damage be detected early and treated accordingly.
Treatment and therapy
In the acute phase, cooling should be applied as quickly as possible. This immediately constricts and closes blood and lymph vessels, reduces or prevents further fluid leakage, and thus reduces the extent of swelling. However, an ice pack should not be used or this cloth should be wrapped to avoid the risk of frostbite. These develop very quickly and show the same symptoms as a burn. A wet cold cloth is sufficient for effective cooling. Furthermore, depending on the size, hemostasis can be achieved by applying pressure to the area with the hand or thumb. To promote the further healing process, there are various ointments that can be prescribed by the doctor. Extracts of arnica, calendula or St. John’s wort or corresponding Schuessler salts additionally support the degradation process. Therapies such as lymphatic drainage can be prescribed by the doctor to reduce swelling. A light stroking from the inside to the outside in the direction of the temple additionally favors the lymph drainage and can be carried out several times a day by the patient himself. In general, the healing process depends on the patient’s physical constitution and age, health condition, any other illnesses or injuries, and the use of medications.
Outlook and prognosis
The prognosis in the case of a hematoma of the eye is generally considered favorable, insofar as it is not associated with any secondary complications. The mere swelling recedes on its own in most cases, although the affected person can accelerate the healing process with various self-performed hand movements. People who take blood thinners or suffer from hemophilia have a less favorable prognosis. The healing of the hematoma will take much longer, although they can also influence the healing by cooling and other methods.If there were complications in connection with the black eye, the prognosis depends on them. Bleeding into the eye or bone fractures are much more serious than a mild infection in the area. The more tissue around the eye and the hematoma is additionally damaged, the less favorable the prognosis. Further bleeding, poorer vision and severe pain also indicate deeper injuries that require further evaluation. Overall, a violet heals well within seven to ten days with adequate cooling. Traces of the hematoma may remain – also depending on the thickness of the skin, age, etc. – for a longer period of time. – still remain for a longer time.
Prevention
Physical fitness is an important aspect to prevent a black eye or even other hematomas or to keep the extent low after a fall or accident. Strong circulation, regular heart rhythm and healthy blood pressure are factors that prevent excessive bleeding. For this, regular checkups with a doctor are recommended.
Follow-up care
A black eye can occur in varying degrees of severity, so in some cases, multiple follow-up visits may be necessary. A black eye is a bruise that occurs directly on the eye. Normally, no medical or drug treatment is necessary at all. A black eye subsides independently after a few days, so that nothing should stand in the way of a complete and prompt recovery. Since a black eye usually develops due to a strong external force, a doctor should be consulted in particularly bad cases. If the swelling or the bluish discoloration does not subside after five to six days, the affected person should opt for an appropriate follow-up examination. Under certain circumstances, a fracture may be present in the face due to the impact of the force. Such a fracture can only be detected by an appropriate examination. Therefore, a black eye is usually not a medical condition that requires a medical examination or a follow-up examination. However, if the swelling of the eye is particularly severe, the person concerned should opt for a follow-up examination. Only through such a follow-up examination can further complications be detected and avoided at an early stage. This will ensure a full recovery.
What you can do yourself
A black eye does not necessarily require medical treatment. It is usually sufficient to cool the hematoma immediately with ice, [[cold-warm compress|cold packs], a cottage cheese poultice or a bag of frozen vegetables. It should be noted that the ice should not be in direct contact with the skin to avoid frostbite. In the following days, the black eye can be treated with warm compresses. In addition, various home remedies such as arnica or chamomile can be applied, for example in the form of an ointment or as a tincture. Natural anti-inflammatories such as lemon balm or ginger can also be repeatedly applied to the hematoma. During the healing phase, the black eye should be protected from further damage by applying a suitable bandage. Sports goggles and other protective equipment should be worn during sports. During sleep, the eye can be protected by sleeping on the other side. As an optical measure, it is recommended to cover the black eye with make-up or camouflage. After one to two weeks at the latest, the hematoma should have finally subsided. If pain or discoloration persists, a visit to the doctor is recommended.
