The term raccoon eyes, or panda eyes in some areas, refers to a dark purple discoloration forming around the eyes, giving an appearance similar to that of a raccoon or panda. While the phrase aptly describes the patient’s countenance, it should not be confused with an ordinary black eye. In fact, the distinction between the two is that the latter is usually earned during an unfortunate encounter with another person’s fist making direct contact with the eye socket. The phrase raccoon eyes, on the other hand, is a layman expression for periorbital ecchymoses, which typically follows suffering a fracture at the base of the skull within a few days of the incident. In addition, the bruising is always exhibited bilaterally, meaning in both eyes simultaneously.
The mechanics involved in experiencing raccoon eyes is quite different as well. As mentioned above, this condition doesn’t stem from facial trauma and simple bruising of the orbital region. In contrast, the bilateral discoloration develops in response to a blow to the base of the skull so intense that it causes tears to occur in the meninges, special membranes belonging to the central nervous system. This event then permits blood to pass into the dural venous sinuses and ultimately into the arachnoid villi, or the secondary soft tissue layer of the brain. In short, there is internal bleeding going on.
The appearance of raccoon eyes in a patient may be the only clue that a basal skull fracture has even occurred. In fact, this type of injury often escapes detection from x-rays. Of course, once a physician has observed the distinctive markings that are characteristic of this condition, he or she may then attempt to reconstruct a timeline of events to try to pinpoint when the underlying injury may have taken place and how long the internal bleeding has been occurring.
The next step for the physician to undertake is cranial damage assessment. Obviously, bleeding has already been established. However, there can be secondary complications, such as nerve damage, that may impair sense of smell, hearing, or vision. Another concern is the potential for cerebrospinal fluid to enter into and escape from the nose or ears. If any drainage from the cavities is apparent, the fluid will be test for the presence of glucose. A positive result indicates that the fluid does, in fact, contain cerebrospinal fluid.
Other symptoms that commonly accompany having raccoon eyes include bulging of the the eardrum, loss of tactile feeling or facial muscle paralysis, an altered level of consciousness, headache, and nausea. Should any person experience these symptoms in connection with a fall or blow to the head, immediate medical assistance is warranted. In particular, the development of raccoon eyes suggests that a full neurological evaluation should be performed. In extreme cases, surgical intervention may be necessary to repair extensive damage to membranes.