How To Treat a Black Eye

If both eyes are black, it could mean big trouble.

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Bruising around both eyes can be a sign of skull fracture. Paul Viant/The Image Bank/Getty Images

Black eyes are caused by bruising of the skin and cheek fat around the eye bones (orbits). The medical term for a black eye is periorbital ecchymosis. Most of the time, black eyes are minor injuries that, like any bruise, will fade with time and disappear. You don't have to treat it, but the three steps below might make the swelling and pain go away a little bit quicker.

Black eyes can also be a sign of a more significant injury—especially if both eyes are black following a significant injury to the head.

Blood accumulating around both eyes after an injury to the head could be a sign of basal skull fracture, which is a break in the bones that provide the floor of the skull where the brain rests. Bilateral black eyes should be considered an emergency and the patient should be assessed for other signs of basal skull fracture.

Call 911 immediately if you see any of the following after trauma to the head or face:

  • bleeding from the eyeball (DO NOT apply pressure)
  • loss of consciousness (patient got knocked out)
  • two black eyes (also known as "raccoon eyes" or "panda sign")—especially if the injury was to a part of the head other than the face
  • confusion
  • loss of vision or blurred vision
  • vertigo (dizziness)

Assuming the above signs and symptoms of major injury are not present, you can treat basic black eyes using the following steps:

Steps

  1. During the first 24-48 hours, place an ice pack lightly on the black eye for about 20 minutes of each waking hour. Do not leave ice on the eye for more than 20 minutes at a time. Don't put pressure on the eye. Just let the ice rest there.
  1. After the first 48 hours, changing from ice to heat may improve healing. Again, only about 20 minutes at a time, about once an hour. Not too hot, just enough to provide a little warmth and promote blood flow.
  2. Watch the eye for swelling or infection. If the patient's vision is obstructed from swelling, or there is drainage or bleeding from the eye, call a doctor.

    Tips

    1. Never put raw meat on a black eye. There is a first aid myth that putting a steak on a black eye will help it heal faster. It will not. In fact, putting raw meat on a black eye is more likely to cause an infection (see E coli).
    2. Never put pressure on the eyeball. Eyes are delicate and pressure can lead to serious permanent injury. There is a fluid inside the eyeball with the consistency of jelly. This fluid is called vitreous humor and it helps the eye maintain its shape. The shape of the eye is essential for proper function. Any pressure, even light pressure, on a ruptured eyeball can cause the loss of vitreous humor and permanent loss of vision. 
    3. Ice works to decrease swelling, but there's not really anything that can be done for the discoloration. It will eventually fade.

    Sources:

    Kayiran O, Calli C. The Effect of Periorbital Cooling on Pain, Edema and Ecchymosis After Rhinoplasty: A Randomized, Controlled, Observer-blinded Study. Rhinology. 2016 Mar;54(1):32-7. doi: 10.4193/Rhin15.177. PubMed PMID: 26713321.

    Pessa JE, et al. Anatomy of a "Black Eye": A Newly Described Fascial System of the Lower Eyelid . Clin Anat. 1998;11(3):157-61.

    Somasundaram, A., Laxton, A., & Perrin, R. The Clinical Features of Periorbital Ecchymosis in a Series of Trauma Patients.  Injury. 45(1), 203-205. doi:10.1016/j.injury.2013.09.010

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