What is a spectacle hematoma?
A spectacle hematoma is bruising that spreads around the orbit of the eye and thus discolors the lower and upper eyelid and the surrounding regions. The bleeding gives the skin a different color, which can vary from black/blue to brown/yellow, depending on how old the hematoma is. A spectacle hematoma can occur on both sides and, as the name suggests, is similar in appearance/shape to spectacles.
This type of hematoma is also referred to as a periorbital hematoma, eyeglass hematoma, spectacle haematoma or simply as a black eye in everyday language. If such a hematoma is only present on one side, it is called a monocular hematoma (monocular is derived from Latin and means “one eye”).
Causes of a spectacle hematoma
The most common cause of a spectacle hematoma is a fracture of the base of the skull due to an external violent impact. A spectacle hematoma is always accompanied by a discoloration of the affected skin area.
Symptoms of a spectacle hematoma
A colored bruising around the eye is the primary symptom of a spectacle hematoma. Depending on the age of the hematoma, the color can vary from black to blue to yellow. In addition, the area around the eye is swollen. Due to the leaked blood, which is only gradually broken down, a pressure-sensitive swelling develops. Depending on the size of the swelling, it is possible that the eye can no longer be opened properly. A further accompanying symptom can be a feeling of pressure as well as numbness in the affected body region. Also noteworthy is the pain that occurs when having a spectacle hematoma.
Pain caused by a spectacle hematoma
With a spectacle hematoma, a lot of blood has flowed into the tissue around the eye. In most cases, a spectacle hematoma is caused by a violent impact and thus the consequence of a severe vascular injury. The accompanying pain is correspondingly high. The region is particularly sensitive to pain when pressure is applied.
The leaking blood automatically creates pressure on the surrounding tissue, including the nerves and pain receptors, which causes pain. When the swelling subsides, the pain also subsides. Swelling is one of the characteristic symptoms of a spectacle hematoma.
Swelling due to a spectacle hematoma
When blood enters the tissue through a vascular injury, the tissue swells. The blood is only gradually broken down by the body, and the swelling remains just as long. The pressure exerted by the blood on the tissue also causes pain and sensitivity to pressure.
The swelling can lead to the affected person not being able to open their eyes or hardly being able to open them at all. In severe cases, the field of vision may be reduced until the swelling subsides. In the case of a spectacle hematoma, the doctor will first consult the patient after an accident or fall to make a diagnosis.
This serves to investigate the cause and is intended to rule out diseases that may also cause hematomas. The patient is allowed to tell the doctor his or her story about the exposure to violence and to point out the area that is painful. Now the area around the eyes is examined and attention is paid to red skin discoloration.
Spectacle hematoma treatment
Cooling (on the first days), warm compresses (after a few days), creams, gels and herbal preparations containing the active ingredient of the arnica plant can be used to treat a spectacle hematoma. These treatment options are detailed below.
Cooling a spectacle hematoma to reduce pain and swelling
The area affected by a spectacle hematoma can be cooled. Cooling contracts the injured vessels and thus prevents further bleeding into the surrounding tissue.
This in turn keeps the resulting swelling as small as possible and thus keeps the pain as low as possible. Furthermore, the pain is not perceived as well due to the cold. For cooling, we recommend a cool pack that is wrapped in fabric to prevent the tissue from being damaged by the cold.
Warm compresses for a spectacle hematoma
A few days later the healing of the affected area should be stimulated. Warm compresses help here, as they increase the blood circulation and thus the leaked blood can be broken down more quickly. It is also advisable to put your head up at night so that all secretions can drain away from the affected areas.
Do creams and gels help?
Care should be taken with creams and gels that thin the blood and thus help the hematoma to possibly disappear more quickly, as the leaked blood is broken down more quickly. Such preparations are usually used for hematomas on the arms and legs and, if used incorrectly, can get into the eye and damage the conjunctiva there. The use of these products should be clarified with the doctor.
Arnica for pain relief
Herbal preparations with the active ingredient of the arnica plant can also be used for the healing process and for pain relief. When suffering from spectacle hematoma, the cause is usually a skull base fracture. This is a bone fracture in the area of the base of the skull, which is caused by a strong violent impact on the head.
Spectacle hematoma due to a skull base fracture
A skull base fracture injures many vessels which can lead to a spectacle hematoma. Another cause can be a fracture of the bony orbit, which is caused by a punctual violent impact on this region. In such a fracture, if it is unilateral, a hematoma exists only on one side (monocular hematoma).
It is similar with injuries caused by a violent impact on the soft tissues in the orbital region. A fracture of the base of the skull can be the cause of a spectacle hematoma, because in this severe head injury numerous vessels are cut through, which can then bleed into the skin. The cause of a skull base fracture is a physical force, such as the impact of a traffic accident or a blow to the head in the case of physical violence.
In case of a basal skull fracture, the bone sutures connecting the individual skull plates break in the area of the cranium. The bone connections are the weakest parts of the skull, as they do not completely grow together until childhood. Which sutures break apart is different and depends on the force applied.
Spectacle hematoma due to an uncontrolled fall
In the event of an uncontrolled fall, it is not always possible to prevent the head from hitting the ground. As a rule, it is possible to brace or support yourself with your arms. If this is not the case, a spectacle hematoma can occur due to the external force applied to the skull bone.
A fall can have various causes, for example slipping on black ice, falling down stairs, falling with a bicycle or simply stumbling and falling to the ground. With the more force you fall to the ground, the worse the consequences of a fall can be. The height from which you fall is also crucial, so falling down stairs, for example, is very dangerous and can lead to a spectacle hematoma, which can be caused by a fracture of the base of the skull.
How long is a spectacle hematoma visible?
A spectacle hematoma is visible for at least seven days. On the first day after the violent impact on the eye region, the damaged tissue swells and the bruise turns red. The swelling and discoloration depend on the size of the vascular injuries.
After 24 to 96 hours the bruise turns black/blue. The change in color is caused by the breakdown of the leaked blood. Now the color changes to a dark green after about four days.
From the 7th day on the bruise is yellowish and begins to fade more and more. The swelling has usually decreased earlier. When the discoloration is no longer visible and the affected area is pressure-resistant again, the spectacle hematoma has healed.
Spectacle hematoma complications
A complication of a spectacle hematoma can be a basal skull fracture. A skull fracture usually heals without further complications and does not leave any late effects. However, it is also possible that a basal skull fracture leads to bleeding inside the skull.
In addition, a basal skull fracture can lead to encephalitis and cerebral fluid can leak out due to the strong violent impact and the resulting injury. In addition, pus can accumulate in the region of the hematoma. Then it is possible that an abscess has formed as a complication.
A monocular hematoma (hematoma on one side) is also called a “black eye” colloquially. It is a bruise in the area of the upper and/or lower eyelid of only one eye. As a rule, a monocular haematoma is the result of a localized violent impact, such as a blow or impact from an accident or fall.
Boxers and other people involved in martial arts or combative sports are often affected by a monocular hematoma. In addition to the hematoma, the bony structure around the eye may also be broken. The skin around the eye is discolored bluish, sensitive to pressure and painful until the bruise has healed on its own.