Black eye: Symptoms, diagnosis and treatment

What is a black eye?

A 'black eye' is a bruise to the eyelid skin caused by blunt trauma to the eye region of the face. Like many bruises, a "shiner" may be nothing to worry about and might resolve on its own in a few days. In some cases, however, a black eye is a warning sign of more serious injury to the eye or to the skull. Any damage to the eyeball that causes it to become red and swollen must be promptly evaluated by a doctor. Blunt force eye injuries (as happens in fighting, competitive sports and ordinary accidents) could involve an unsuspected detached retina, internal bleeding, or other serious problems. A fracture involving the delicate bones around the eye may trap an eye muscle or soft tissues. An orbital fracture could damage the optic nerve and permanently damage eyesight. If so, emergency surgery may be required to correct the condition.

What causes it?

Most black eyes are the result of blunt trauma that causes bleeding beneath the thin eyelid skin, producing the characteristic blue-black discoloration. A fracture deep inside the skull can also cause black eyes to both eyes, even though the eye area itself was not injured. People with sinusitis from allergies sometimes get "allergic shiners", darkening under the eyes caused by inflamed and engorged blood vessels.

What are the symptoms of a black eye?

The symptoms of a black eye include bruising and swelling of the eyelid and soft tissue around the injured eye, sometimes accompanied by broken blood vessels along the white of the eye (subconjunctival haemorrhage). The discoloration starts out deep purple or blue. As the bruise resolves, it may turn green or yellow before disappearing, usually in about a week.

Seek medical advice for a black eye if:

• There was loss of consciousness as a result of the injury.
• Black eyes spontaneously appear affecting both eyes; you should be examined by a doctor for possible skull fracture.

Any of the symptoms below may indicate damage to the eyeball, which should be evaluated and treated by a doctor or an ophthalmologist:

• Your eyeball hurts.
• You have an open cut around the eye.
• You have blurred vision, or see multiple images or floating spots.
• You see blood or other abnormalities involving the coloured iris or round pupil.
• You experience unusual sensitivity to light or other vision changes.

What are the treatments for a black eye?

To treat a black eye, begin with basic first aid. Applying something cold to a black eye works in two ways: It helps to reduce swelling and it constricts blood vessels, which in turn stops the internal bleeding. Putting a cold steak on a black eye is a needlessly expensive variation. You can save money by making your own crushed ice pack or use a bag of frozen vegetables, which works just as well – make sure these are wrapped in a cloth when applied to the black eye.

Besides cold treatment, there's not much that can be done for a black eye except to avoid doing anything that could cause further injury, such as putting pressure on the swollen eye or trying to force it open. If you need a pain reliever, take an analgesic such as paracetamol or ibuprofen.

Remember, you will not be able to determine the possibility of eye damage by simply looking in the mirror. If the eyeball itself is damaged or if vision is affected, your doctor or ophthalmologist is best qualified to determine the nature and extent of any eye injuries and to give appropriate treatment. Time is critical! Do not hesitate to seek medical assistance whenever eye trauma occurs.