What Are Raccoon Eyes And What Is Causing Them?

If your eyes appear darkened, even when you feel well-rested, it's vital to get to the root of the problem. Darkened skin around the eyes can have many causes, from lack of sleep and allergies to more serious underlying medical conditions. Periorbital ecchymosis, colloquially known as raccoon eyes, is another common culprit, says WebMD. It happens when tiny blood vessels under the eyes bleed, leading to bruising.

It is important to note that raccoon eyes are not the same as the dark circles that can appear under the eyes when you are tired — dark circles do not typically involve bleeding or bruising. Periorbital ecchymosis, on the other hand, can be a symptom of a more serious medical condition or problem. If you experience raccoon eyes along with symptoms such as a lump or head swelling, dizziness, nausea, and fluid draining from your nose or ears, it is important to seek medical attention. Your doctor can help determine the underlying cause and develop an appropriate treatment plan. Continue reading as we explore the various causes.

One of the most common causes of raccoon eyes is trauma, injury, or surgery (such as rhinoplasty). When the face is injured, blood vessels around the eyes can rupture, causing blood to pool in the area — this can result in the characteristic darkened appearance around the eyes.

Injury to the skull, also known as a basal skull fracture, is another factor. This occurs when the bone at the base of the skull is fractured, typically when someone is hit or struck in the face or involved in a car accident, says Medical News Today. The basal skull includes the occipital, temporal, sphenoid, and ethmoid bones. Depending on the location and severity of the injury, one or more of these bones can be affected. The symptoms of a basal skull fracture may include darkened skin under the eyes, along with other symptoms such as headache, dizziness, and hearing loss.

Amyloidosis is another common cause — this can result in the buildup of abnormal proteins, known as amyloid fibrils, in tissues and organs throughout the body. The accumulation of these proteins can cause damage to organs and tissues, leading to a wide range of symptoms and complications, explains the Cleveland Clinic. 

Raccoon eyes can be a sign of cancers such as neuroblastoma. Less commonly, raccoon eyes might indicate an infection or other medical condition such as sinusitis, allergies, pertussis, or thrombocytopenia, among others.

In many cases, the condition doesn't need treatment and may go away on its own, though it may take a couple of weeks to clear. This is especially true if caused by trauma or injury (per Medical News Today). Your doctor may order imaging tests like X-rays or CT scans to determine the underlying cause. Although the condition can heal on its own, in cases where raccoon eyes are caused by a skull fracture or head injury, urgent medical attention is needed. Lack of treatment can lead to complications such as bleeding in the brain or other neurological damage. In general, treatment for a skull fracture may include observation and monitoring, medication, or surgery.

In cases where raccoon eyes are caused by an underlying medical condition such as amyloidosis, sinusitis, or neuroblastoma, treatment will depend on the specific condition and may involve surgery or other medical interventions. The goals of treatment for amyloidosis are to reduce the production of abnormal proteins and to manage symptoms and complications. If caused by sinusitis, antibiotics and over-the-counter decongestants may kill the infection, reduce inflammation, and improve blood flow in the area around the eyes, explains the Mayo Clinic. Nasal corticosteroid sprays may also be used to reduce inflammation and improve symptoms. As for neuroblastoma, treatment involves removing the tumor (or parts of the tumor) as soon as possible. Surgery may be used alone or in combination with other treatments. Chemotherapy medications may be used to kill cancer cells throughout the body and are often combined with other treatments.