Raccoon eyes, also known as panda eyes or periorbital ecchymosis, is a

sign A sign is an object, quality, event, or entity whose presence or occurrence indicates the probable presence or occurrence of something else. A natural sign bears a causal relation to its object—for instance, thunder is a sign of storm, or me ...

of basal skull fracture or

subgaleal hematoma Subgaleal hemorrhage, also known as subgaleal hematoma, is bleeding in the potential space between the skull periosteum and the scalp galea aponeurosis (dense fibrous tissue surrounding the skull). Symptoms The diagnosis is generally clinical, ...

, a

craniotomy A craniotomy is a surgery, surgical operation in which a bone flap is temporarily removed from the Human skull, skull to access the Human brain, brain. Craniotomies are often critical operations, performed on patients who are suffering from brain ...

that ruptured the

meninges In anatomy, the meninges (; meninx ; ) are the three membranes that envelop the brain and spinal cord. In mammals, the meninges are the dura mater, the arachnoid mater, and the pia mater. Cerebrospinal fluid is located in the subarachnoid spac ...

, or (rarely) certain

cancers Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

. Bilateral

hemorrhage Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, ...

occurs when damage at the time of a facial fracture tears the meninges and causes the venous sinuses to bleed into the

arachnoid villi Arachnoid granulations (also arachnoid villi, and Pacchionian granulations or bodies) are small outpouchings of the arachnoid mater and subarachnoid space into the dural venous sinuses of the brain. The granulations are thought to mediate the dra ...

and the cranial sinuses. In lay terms, blood from skull fracture seeps into the soft tissue around the eyes. Raccoon eyes may be accompanied by Battle's sign, an

ecchymosis A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur clo ...

behind the ear. These signs may be the only sign of a skull fracture, as it may not show on an

X-ray An X-ray (also known in many languages as Röntgen radiation) is a form of high-energy electromagnetic radiation with a wavelength shorter than those of ultraviolet rays and longer than those of gamma rays. Roughly, X-rays have a wavelength ran ...

. They normally appear between 48 and 72 hours (2-3 days) after the injury. It is recommended that the patient not blow their

nose A nose is a sensory organ and respiratory structure in vertebrates. It consists of a nasal cavity inside the head, and an external nose on the face. The external nose houses the nostrils, or nares, a pair of tubes providing airflow through the ...

, cough vigorously, or strain, to prevent further tearing of the meninges. Raccoon eyes may be bilateral or unilateral. If unilateral, it is highly suggestive of

basilar skull fracture A basilar skull fracture is a bone fracture, break of a bone in the base of skull, base of the skull. Symptoms may include Battle sign, bruising behind the ears, periorbital ecchymosis, bruising around the eyes, or hemotympanum, blood behind the ...

, with a

positive predictive value The positive and negative predictive values (PPV and NPV respectively) are the proportions of positive and negative results in statistics and diagnostic tests that are true positive and true negative results, respectively. The PPV and NPV desc ...

of 85%. They are most often associated with fractures of the

anterior cranial fossa The anterior cranial fossa is a depression in the floor of the cranial base which houses the projecting frontal lobes of the brain. It is formed by the orbital plates of the frontal, the cribriform plate of the ethmoid, and the small wings and ...

. Raccoon eyes may also be a sign of disseminated

neuroblastoma Neuroblastoma (NB) is a type of cancer that forms in certain types of nerve tissue. It most frequently starts from one of the adrenal glands but can also develop in the head, neck, chest, abdomen, or Vertebral column, spine. Symptoms may include ...

amyloidosis Amyloidosis is a group of diseases in which abnormal proteins, known as amyloid fibrils, build up in tissue. There are several non-specific and vague signs and symptoms associated with amyloidosis. These include fatigue, peripheral edema, weigh ...

, Kaposi’s sarcoma or

multiple myeloma Multiple myeloma (MM), also known as plasma cell myeloma and simply myeloma, is a cancer of plasma cells, a type of white blood cell that normally produces antibody, antibodies. Often, no symptoms are noticed initially. As it progresses, bone ...

. It also can be temporary result of

rhinoplasty Rhinoplasty (, nose + , to shape), commonly called nose job, medically called nasal reconstruction, is a plastic surgery procedure for altering and reconstructing the human nose, nose. There are two types of plastic surgery used – plastic sur ...

. Depending on cause, raccoon eyes always require urgent consultation and management, whether

surgical Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery ...

(facial fracture or post-craniotomy) or

medical Medicine is the science and Praxis (process), practice of caring for patients, managing the Medical diagnosis, diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care, palliation of their injury or disease, ...

(neuroblastoma or amyloidosis).

References

{{General injuries Periorbital conditions Medical signs de:Blaues Auge#Brillen- und Monokelhämatom

See also

References