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Raccoon Eyes - Causative Factors, Diagnosis, Complications, and Treatment

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Raccoon eyes are a clinical sign of trauma caused to the skull base. To know more about the raccoon eyes, read the article below.

Written by

Dr. A. Srividya

Medically reviewed by

Dr. Priyanka

Published At August 29, 2022
Reviewed AtFebruary 21, 2023

Introduction

Raccoon eyes, also known as panda eyes, panda sign, or the periorbital hematoma, are characterized by a purplish halo around the orbit due to the collection of blood outside the eyes' blood vessels under the soft tissues of the eyes.

What Are the Causative Factors Associated With Raccoon Eyes?

Multiple factors cause raccoon eyes. These factors include:

  • Trauma

    • The trauma to the orbit, including non-accidental injuries, and trauma to the thorax, are associated with raccoon eyes.

    • Trauma to the orbit leads to entrapment of air in the paranasal sinus and the development of raccoon eyes.

  • Vascular Diseases - Vascular conditions also contribute to the formation of raccoon eyes. The vascular lesions include:

    • Narrowing of the ophthalmic arteries.

    • Giant cell arteritis.

    • Benign intracranial hypertension.

    • Acute migraine.

  • Infections - Infections of the head and neck region clinically presenting as raccoon eyes are:

    • Severe adenovirus infection.

    • Frontal sinus mucocele.

    • Leukoedema.

  • Genetic Conditions - Genetic diseases like hemophilia also present clinically as raccoon eyes.

  • Post-surgeries - In some cases, the raccoon eyes manifest after surgery due to the rupture of the arteries surrounding the eyes. Surgeries linked to the development of raccoon eyes are:

  • Cancer - Some malignancies are also associated with raccoon eyes:

  • Metabolic Diseases - The primary metabolic diseases that cause raccoon eyes are:

    • Amyloidosis. The deposition of amyloid protein inside the blood vessels increases the fragility of the vessels, leading to the rupture of the vessels.

    • Sarcoidosis.

  • Immune-mediated Skin Disorders - Several skins develop raccoon eyes due to the inflammatory reactions, vascular damage, and edema initiated by the disease. Skin lesions causing raccoon eyes are

    • Lichen planus pigmentosus.

    • Sweet syndrome.

    • Neonatal erythematosus.

What Is the Main Mechanism Involved Behind the Formation of Raccoon Eyes?

Raccoon eyes are the clinical sign presented because of the damage caused to the blood vessels surrounding the orbits. There is pooling and seepage of the blood from the vessels into the adjacent skin. The damage to the blood vessels can occur due to several reasons, mainly because of the skull base fracture.

What Are the Clinical Signs Presented by Patients With Raccoon Eyes?

The presentation of the raccoon eyes may involve either one eye or both eyes—periorbital hematoma forms within seventy-two hours of the injury. In addition, there is purplish discoloration of the skin surrounding the orbit—patients who have raccoon eyes present with three classical signs.

  • Bulging eyes.

  • Discoloration of orbital skin.

  • Swelling or edema.

Other clinical presentations associated with raccoon eyes are:

  • Blood behind the ears (battle's sign).

  • Loss of hearing.

  • Increase in blood pressure.

  • Double vision.

  • Bruises around the eyes.

  • Distorted vision.

  • Bleeding nose.

  • Weakness of face and nose.

  • Red-eye.

What Are the Symptoms Reported by Patients Having Raccoon Eyes?

Patients with periorbital hematoma often complain of:

  • A localized pain in the region of the edema.

  • Sensory Changes - There is a change in sensory functions of smell, hearing, and vision.

  • Muscle weakness.

  • Patients with neuroblastoma also complain of dilation of the pupil and bone pain.

  • Amyloidosis patients suffer from drooping of the eyelids, eyeball protrusion, growth in the surrounding region, and pain.

  • Change in the function of smell.

What Are the Various Diagnostic Techniques Adopted in Patients With Raccoon Eyes?

Raccoon eyes are itself a clinical sign caused by an underlying disease. Therefore, the primary goal of the specialist remains to identify the primary cause of the entity. The diagnosis thus comprises:

  • Clinical Examination - A comprehensive evaluation of ocular structures, including the head and neck region, is essential.

  • History - The specialist should acquire complete history from the patient regarding trauma, the onset of the discoloration, and medical history.

  • Imagings - Imagings such as computed tomography (CT) of the skull before surgery help delineate the skull base fractures.

What Are the Complications That Can Occur in Patients Exhibiting Raccoon Eyes?

Raccoon eyes are a clinical sign. Hence raccoon eyes themselves will not cause any complications. The basal cause, such as the skull base fracture, amyloidosis, etc., if left untreated, might result in several complications such as -

  • Infection of the meninges.

  • Blood in eyes.

  • Paralysis of facial muscles.

  • Brain hemorrhage (bleeding).

  • Cerebrospinal fluid leaks.

  • Skull abnormality

  • Facial deformity.

  • Injury to cranial nerves.

  • Spine injuries.

What Are the Conditions to Be Considered During the Diagnosis of Raccoon Eyes?

Raccoon eyes are most commonly caused by trauma to the anterior skull base. However, clinical conditions which can also present with raccoon eyes include:

How Are Patients With Raccoon Eyes Treated?

Raccoon eye does not require any treatment; the ecchymosis resolves within two to three weeks. Patients are advised not to blow their noses vigorously or sneeze to avoid tearing the meninges. However, the hidden cause responsible for the clinical manifestation requires treatment.

  • Surgery and rehabilitation of the fracture are advised in case of skull fractures.

  • Neuroblastoma or tumors related to that region requires surgical excision or chemoradiation management.

  • Amyloidosis associated with raccoon eyes is treated by reducing the amount of amyloid protein in the blood.

  • Cosmetic surgery may be performed if the facial structure is compromised.

What Is the Post-treatment Protocol to Be Followed in Patients With Raccoon Eyes?

Patients with raccoon eyes are kept under regular follow-up to monitor the progress of the underlying disease before and after treatment.

What Is the Role of Health Care Professionals in Managing Raccoon Eyes?

The healthcare teams, including nurses and primary care physicians, dealing with patients presenting with raccoon eyes should ask about the history of trauma or any other diseases. Prompt referral and diagnosis of the causative factor will help get a better resolution of the disease condition.

What Is the Overall Outlook of Raccoon Eyes?

The end outlook of the disease entity depends on the severity and prognosis of the underlying disease. Eventual healing of the skull base fracture results in fading away of the sign; however, some conditions require professional intervention.

Conclusion

Raccoon eyes are the primary clinical manifestation of trauma to the skull. It is caused due to the pooling of damaged blood vessels. Therefore, complete patient history and evaluation are crucial in forming an appropriate diagnosis and treatment strategy.

Frequently Asked Questions

1.

What Do Raccoon Eyes Mean?

Raccoon eyes are purplish or bluish bruising on the skin under the eyes. It is indicative of an external injury. However, it can also indicate an underlying severe condition like skull or brain injuries.

2.

Is It Normal to Have Raccoon Eyes?

Raccoon eyes are not part of the normal phenomena. Instead, it indicates the hematoma or flushing of the blood around the orbits following injury. The raccoon eyes or the panda sign are most commonly seen in the periorbital region.

3.

Is It Possible to Fix Raccoon Eyes?

Raccoon eyes do not require treatment. In raccoon eyes caused due to injury, the pooling of blood around the eyes gets resolved by itself. The patient must not rub their nose vigorously or sneeze. If there is no underlying cause, it needs to be treated.

4.

Why Do Children Get Raccoon Eyes?

Raccoon eyes in adults might be related to trauma or any underlying condition which can be easily detected clinically. Raccoon eyes of children are always associated with a hidden underlying cause like Kaposi’s sarcoma, multiple myeloma, neuroblastoma, etc.

5.

Can Babies Have Raccoon Eyes?

Raccoon eyes may also be seen in neonates or infants. The main cause of periorbital hematoma in infants is basal skull fracture or neuroblastoma. Subgaleal hematoma occurs on the first day of life.

6.

What Is Mean by Bulging Eyes?

Bulging of the eyes is caused by thyroid diseases, such as hyperthyroidism or Grave’s disease. Other ocular diseases like glaucoma may also cause protrusion of the eyes due to an increase in the pressure inside the eyes.

7.

Is Bulging of Eyes a Serious Problem?

Bulging of eyes, especially one eye in the case of children, indicates the presence of hyperthyroidism or Graves disease. Children suffering from Graves disease also present with gritty sensations in the eye, eyelid swelling, redness, and irritated or watering eyes.

8.

Is It Possible to Correct Bulging Eyes?

Mild bulging of the eyes does not require treatment and may go by itself. However, in severe cases, where there is a danger of permanent disfigurement, bulging of the eyes can be treated extensively with surgery such as orbital decompression surgery.

9.

Can Lack of Sleep Make Eyes Bulge?

Lack of sleep or staying awake for longer periods of time may lead to dryness of the eyes. It may also lead to irritation of the eyes along with swelling and puffiness of the eyes. In addition, lack of sleep leads to expansion of the blood vessels resulting in a reddish-blue appearance.

10.

How to Manage Eye Bulge?

Eye bulging can be managed with various methods like eye drops, antibiotics, steroids, etc. In case of severe bulging of the eyes surgery, chemotherapy, or radiation are the preferred means of correction. If underlying diseases cause the bulging of the eyes, the condition must be managed.

11.

Can a Bulge of the Eye Occur Genetically?

Bulging of the eyes can also be present at the time of birth. It is more commonly associated with other genetic conditions such as congenital thyroid disease, Graves disease, and Crouzon syndrome. In addition, there is the protrusion of the eyes.

12.

Is Meningitis Serious?

Meningitis is defined as the inflammation of the meninges. Meningitis is a serious condition that, if left untreated, can cause serious damage to the brain and nerves. Bacterial meningitis can become fatal within twenty-four hours of infection.

13.

What Are the Various Types of Meningitis?

There are different types of meningitis based on the organism causing the infection. The three major types of meningitis are bacterial meningitis, fungal meningitis, and viral meningitis. Apart from the three major types, other types are parasitic meningitis and non-infectious meningitis.

14.

Is It Possible for a Person to Survive Meningitis?

Meningitis, if treated in time, does not cause any fatal damage. However, bacterial meningitis is the most serious of all meningitis, with the condition becoming fatal within twenty-four hours of infection if the appropriate treatment is not initiated in time. It can also cause permanent damage like brain damage, hearing loss, etc.

15.

How Do Adults Aquire Meningitis?

Meningitis in adults is mostly acquired by contact. The infectious agent's transmission occurs from the infected patient's air droplet or saliva. It can also occur by sneezing, sharing personal belonging, sneezing, coughing, etc.
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Dr. Priyanka
Dr. Priyanka

Ophthalmology (Eye Care)

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