Introduction and Overview
When we are injured by a blow to a body part, for example, if we fall and hit an arm against a railing or other object, the likely result is a bruise, which is caused by broken blood vessels under the skin and bleeding into the tissue in the area. Swelling, a dark blue-black coloration and soreness in the area are common results. The medical term for a bruise is hematoma.
A black eye is also a bruise, and often results from a blunt blow to the area of the face around the eye or eyes. Usually not serious, the force of the impact causes blood vessels to break and form pooling under the skin, especially in the area of the lower lid. In other words, a black eye is a bruise located in the area around the eye. Because the skin is thinner in this area, the color from the broken vessels is more easily seen and appears darker than a bruise elsewhere.
If the blow that causes the black eye is severe, especially if there is a change in vision such as blur, double vision, losing part or all of the visual field, flashes of light or dark spots in the vision, consult an eyecare practitioner without delay. In particular, flashes of light and/or a loss of part of the visual field (often described as “a curtain falling over the vision”) should be checked by an eyecare practitioner as soon as possible, because this could indicate a detached retina and is a sight-threatening emergency.
In addition, if the blow to the face is severe enough, the eyeball and the muscles surrounding it may be compressed back into the orbital space and force the thin bones separating the cone- shaped orbit and the surrounding sinuses (spaces within the skull) to break. Occasionally, the muscle tissue may become trapped within the breakage and cause loss of eye motion control, resulting in double vision. If the bones heal without resolving this issue, the double vision may become permanent.
Any blunt force trauma to the head severe enough to cause a black eye should be evaluated by a physician because there is always a possibility of concussion or other serious brain injury.
Often, we think of such injuries as “just a black eye”, when, in fact, the results of such an injury can be fairly severe and serious.
Signs and symptoms
The eyelids and soft tissues around the eye will swell and become purplish-red to black. There may be a small break in one of the blood vessels under the conjunctiva, called a sub-conjunctival hemorrhage, which can cause the white of the eye to be bright red. The area around the bruising may be reddened and the tissues may swell dramatically.
(Figure 1 shows a subconjunctival hemorrhage, caused by bleeding beneath the clear skin covering the white of the eye. These vivid bruises often accompany the bruising of a black eye, but can also occur spontaneously.)
Consult your eyecare practitioner right away if you experience any of the following:
- Any change in vision
- Flashes of light
- Showers of black spots
- Reduced clarity or blurred vision
- Double vision
- Redness in the white of the affected eye
- Trouble moving the eye
- Numbness on the injured side of the face
- Appearance of the affected eye to be either bigger than the other, or sunk into its socket
- Loss of consciousness, nausea, vomiting or disorientation
To reduce the pain and swelling, gently use cold compresses, using a commercial first-aid product, crushed ice wrapped in a small towel, or a bag of frozen peas or corn wrapped in a small towel. Use the compress for five minutes, remove it and wait two minutes, then repeat the process. Be careful not to press on the eye. Repeat often for comfort and to reduce swelling.
Continue the cold compresses periodically for the first 24 hours, and then use warm compresses for the following three to five days. (A clean washcloth soaked in warm water and wrung out will make a good warm compress. Reheat as necessary.)
A black eye, like any other bruise, will gradually heal and the discoloration will disappear as the leaked blood will be reabsorbed.
(Figure 2 shows a black eye in the course of healing, showing various discolorations as the bruise is resolving.)
Seek medical advice from your eyecare practitioner or your general physician if you notice any of the signs or symptoms listed above.
Protect your eyes! Ninety percent of eye injuries can be prevented by the use of protective eyewear. Everyday activities such as mowing the lawn or doing hobbies such as woodworking should never be done without eye protection.
Mack: How did you get that black eye?
Jack: Do you see that tree over there?
Mack: Yes, of course.
Jack: Well, I didn’t.
All humor aside, protective eyewear is easy to obtain and easy to use. We should all use it just like we should all wear seat belts in our cars, and of course this is even more important for children.