Possible Causes for periorbital ecchymosis Skull Fracture Home CCC Base of Skull Fracture by, last update March 30, 2019 OVERVIEW fracture involving the floor of the cranial vault CLINICAL FINDINGS Periorbital ecchymosis (raccoon [lifeinthefastlane.com] […] by, Last updated August 18, 2013 OVERVIEW fracture involving the floor of the cranial vault CLINICAL FINDINGS Periorbital ecchymosis (Raccoon eyes) CSF rhinorrhoea CSF otorrhoea [lifeinthefastlane.com] ecchymosis often called 'raccoon eyes' (bruising of the orbits of the eyes that result from blood collecting there as it leaks from the fracture site); and retroauricular [en.wikipedia.org] Nasal Fracture The presence of epistaxis, nasal swelling, and periorbital ecchymosis are signs that are suggestive of significant nasal trauma and warrant a thorough internal and external [clinicalgate.com] Physical examination findings include swelling over the nasal bridge, grossly apparent deviation of the nasal bones, and periorbital ecchymosis. [emedicine.medscape.com] ecchymosis Palpation and direct visualization of nasal septum to rule out septal hematoma Helpful to see photo of patient prior to injury Does not require radiographic imaging [medicine.uiowa.edu] Basilar Skull Fracture Periorbital ecchymosis, or "raccoon eyes," is a classic diagnostic sign of basilar skull fracture. [hakeem-sy.com] Physical examination is notable for periorbital and retroaurticular ecchymosis without evidence of a CSF leak. [step2.medbullets.com] (Battle sign), onset 1-3 days after fracture occurred Raccoon eyes: periorbital ecchymosis Clear rhinorrhea or otorrhea "halo" sign: drop of fluid placed on tissue or filter [wikem.org] Neuroblastoma Periorbital ecchymosis and proptosis may occur with retrobulbar metastasis. [web.archive.org] ecchymosis (raccoon eyes), or Horner syndrome due to mass effects back pain or spinal mass, weakness, scoliosis, bone pain with anemia or hematopoietic changes as a sign [clinicaladvisor.com] These include bone pain due to widespread bone metastases, periorbital ecchymosis and proptosis due to retrobulbar metastasis, and abdominal distention and respiratory problems [merckmanuals.com] Zygomatic Fracture Facial bruising, periorbital ecchymosis, soft tissue gas, swelling, trismus, altered mastication, diplopia, and ophthalmoplegia are other indirect features of the injury. [en.wikipedia.org] Neurosensory disturbance, periorbital ecchymosis, malar depression, subconjunctival haemorrhage, trismus and diplopia were recorded. [jpma.org.pk] On clinical examination revealed swelling over the left side of the face with restricted mouth opening, periorbital ecchymosis and subconjuctival haemorrhage without posterior [pubs.sciepub.com] Maxillary Fracture “Panda facies” within 24 to 48 hours • Bilateral circumorbital/periorbital ecchymosis and gross edema ’Racoon eye • Gross circumorbital edema will prevent eyes from opening [slideshare.net] Maxilla moves as a whole when grasped above upper teeth Crepitus LeFort II Face appears abnormally long Periorbital ecchymosis Central face moves as a whole when grasped [fprmed.com] Nasal bones should be X-rayed when: There is swelling and deformity of the nasal dorsum, epistaxis and periorbital ecchymosis; There is nasal obstruction; There is septal [rch.org.au] Temporal Bone Fracture Frequently, a longitudinal fracture may present with ear injuries, mastoid ecchymosis (Battle's sign) or periorbital ecchymosis (raccoon eyes), tympanic membrane laceration [visualdx.com] Red flags CSF otorrhoea / rhinorrhoea Facial nerve paralysis Post-auricular or periorbital ecchymosis Haemotympanum / pinna haematoma / lacerations Severe nystagmus Vertigo [entsho.com] Orbital Metastasis BACKGROUND: Approximately 30% of patients with metastatic (stage M) neuroblastoma present with periorbital ecchymosis from orbital osseous disease. [ncbi.nlm.nih.gov] Proptosis and periorbital ecchymosis (‘raccoon eyes’) are common and arise from retrobulbar metastases. [nature.com] ecchymosis reflects location and extent of orbital disease. [ncbi.nlm.nih.gov] Geographic Tongue Atypical migratory stomatitis and munchausen syndrome presenting as periorbital ecchymosis and mandibular subluxation. stomatitis areata migrans, unlike its analogue on the [lookfordiagnosis.com] Orbital Emphysema ecchymosis. [ncbi.nlm.nih.gov] ecchymosis or emphysema (n 14), and adhesions (n 35). (2) [FIGURE A OMITTED] Traumatic periorbital emphysema secondary to orbital wall fractures is common. [thefreelibrary.com] Differential diagnosis Periorbital ecchymosis without fracture, in which there may be limitation in extraocular movement, not limiting to horizontal gaze. [eyewiki.aao.org] Thoracic Neuroblastoma Proptosis and periorbital ecchymosis (‘raccoon eyes’) are common and arise from retrobulbar metastases. [nature.com] Tumor infiltration of the periorbital bones, typically unilateral, can cause the characteristic periorbital ecchymosis ("raccoon eyes") (Figure 1). [telemedicina.med.muni.cz] Infiltration of periorbital bones may produce periorbital ecchymosis, ptosis and proptosis. [pedclerk.bsd.uchicago.edu] Orbital Floor Fracture Periorbital ecchymosis and edema accompanied by pain are obvious external signs and symptoms, respectively. [emedicine.medscape.com] Clinically, blowout fractures are characterized (in order of frequency) by periorbital ecchymosis, diplopia, subconjunctival hemorrhage, enophthalmos (sunken globe), inferior [mdmag.com] She was initially treated conservatively with antibiotics for right sided periorbital ecchymosis and swelling with intact globe. Visual acuity was normal in both eyes. [omicsonline.org] Kasabach-Merritt Syndrome We report a two- and- half month old Saudi female infant who presented with epistaxis, conjunctival haemorrage and bilateral periorbital ecchymosis. [ncbi.nlm.nih.gov] Extensive bilateral periorbital ecchymosis was documented with bilateral subconjunctival haemorrhage with no discharge ( Figure 1 B). [ncbi.nlm.nih.gov] (A) Extensive bilateral periorbital ecchymosis (B) Apparent bilateral subconjunctival haemorrhage On routine physical examination, she was ill looking, pale, not cyanosed [ncbi.nlm.nih.gov] Chalazion Copyright VisualDx.com Periorbital ecchymosis (i.e., a “black eye”) and the myxedematous changes of systolic heart failure can manifest in the eyelids. 1 Basal cell carcinoma [aafp.org] ecchymosis (“black eye”) Blunt trauma to orbit resulting in disruption of blood vessels Ecchymosis increasing in size over 48 hours, then slowly improving Squamous cell carcinoma [aafp.org] Varicella zoster virus infection Vesicles with surrounding erythema, possible bacterial superinfection; distributed unilaterally on forehead and upper eyelid in a dermatome Periorbital [aafp.org] Rathbun Syndrome Battle\'s sign may be the only outward sign of basilar skull fracture, or it may be accompanied by periorbital ecchymosis (raccoon eyes), conjunctival hemorrhage, nystagmus [checkorphan.org] Traumatic Asphyxia Periorbital ecchymosis and bilateral conjunctival hemorrhages were also seen [Fig.1b]. [casereports.in] ecchymosis, epistaxis and otorrhagia. [ijcasereportsandimages.com] He came to the emergency room with periorbital ecchymosis and bilateral conjunctival hemorrhage. [casereports.in] Traumatic Brain Injury […] behind the ear (Battle sign) or in the periorbital area (raccoon eyes) Loss of smell and hearing, which is usually immediate, although these losses may not be noticed until [merckmanuals.com] […] from the nose (CSF rhinorrhea) or ear (CSF otorrhea) Blood behind the tympanic membrane (hemotympanum) or in the external ear canal if the tympanic membrane has ruptured Ecchymosis [merckmanuals.com] Fracture of the Cribriform Plate Displacement, asymmetry Deformity Eyelid edema Periorbital ecchymosis Periorbital chemosis Subconjunctival hemorrhage Crepitus Internal exam (these suggest fracture) Epistaxis [fprmed.com] Lacerations, ecchymosis (nasal and periorbital), septal deviation, and nasal obstruction may be present. Septal hematoma appears as a purplish bulge on the septum. [merckmanuals.com] The clinical examination of the craniofacial skeleton begins with inspection for localized tenderness, numbness, bleeding, asymmetry, deformity, ecchymosis, periorbital edema [skullbaseinstitute.com] Subperiosteal Hemorrhage Diagnosis, Workup and Treatment This patient presented with a two-day history of sudden left eye proptosis and mild periorbital ecchymosis. [reviewofophthalmology.com] Notes: ( A ) Clinical photograph of patient showing right eye mild subconjuctival hemorrhage and left eye abaxial proptosis with subconjuctival hemorrhage and periorbital [dovepress.com] ecchymosis. ( B ) Lateral view of patient showing proptosis with subconjuctival hemorrhage. ( C )Three weeks post-operatively, left eye of the patient became pre-phthisical [dovepress.com] Cavernous Hemangioma At presentation, upper eyelid edema with periorbital ecchymosis and subconjunctival hemorrhage were noted in the LE. [dovepress.com] To our knowledge, an acute presentation of an orbital cavernous hemangioma with subconjunctival hemorrhage and periorbital ecchymosis has not previously been reported. [dovepress.com] Abducens Nerve Palsy On examination there were left periorbital ecchymosis (Panels A through E) and palpable step-off deformities along the left infraorbital rim and zygomatic arch. [nejm.org] Epidural Hematoma Examine the patient for signs of basilar skull fractures, such as periorbital ecchymosis (raccoon’s eyes), subscleral hemorrhage, retroauricular ecchymosis (Battle’s sign) [medical-dictionary.thefreedictionary.com] Chronic Suppurative Otitis Media One case (1.09%) was classified as grade 4 because of periorbital ecchymosis in addition to edema. [ncbi.nlm.nih.gov] Tolosa-Hunt Syndrome […] cellulitis Synonyms: preseptal cellulitis Translation: periorbitale Cellulitis periorbitale Zellulitis präseptale Cellulitis präseptale Zellulitis periorbital ecchymosis [zeitzfrankozeitz.de] Synonyms: binocular periorbital haematoma (UK) binocular periorbital hematoma (US) panda eyes (pl.) [zeitzfrankozeitz.de] RBN) Comments: Quod vide: optic neuritis orbital septum Translation: Septum orbitale orbital tumor Synonyms: tumor of the orbit Translation: Augenhöhlentumor Orbitatumor periorbital [zeitzfrankozeitz.de] Intracerebral Hematoma Other signs of basilar skull fracture include raccoon’s eyes (periorbital ecchymosis or bruising around the eyes) and Battle’s sign (bleeding and swelling behind the ear). [medical-dictionary.thefreedictionary.com] Meningitis Clinical signs that may lead a physician to suspect a BSF include CSF otorrhoea or rhinorrhoea, bilateral periorbital ecchymosis, Battle's sign, peripheral facial nerve palsy [doi.org] Clinical signs that may lead a physician to suspect a basilar skull fracture include CSF otorrhoea or rhinorrhoea, bilateral periorbital ecchymosis, Battle's sign, peripheral [doi.org] Proliferating Angioendotheliomatosis ecchymosis, photosensitivity (acquired), PCT, premature graying (poliosis), trichomegaly (acquired), vitiligo neoplastic ; BCC, extramedullary plasmacytoma, lymphoma, SCC [dermadvocate.net] Varicella zoster miscellaneous ; alopecia areata, aphthous ulcers, drug reactions, eosinophilic folliculitis, GA, gingival hypertrophy, hyperalgesic pseudothrombophlebitis, periorbital [dermadvocate.net] Depressed Skull Fracture Home CCC Base of Skull Fracture by, last update March 30, 2019 OVERVIEW fracture involving the floor of the cranial vault CLINICAL FINDINGS Periorbital ecchymosis (raccoon [lifeinthefastlane.com] 'Raccoon eyes' (periorbital haematoma) as a sign of skull base fracture. PMID 11754879 Tubbs RS, Shoja MM, Loukas M, wt al. [en.wikipedia.org] William Henry Battle and Battle's sign: mastoid ecchymosis as an indicator of basilar skull fracture. J Neurosurg. 2010 Jan;112(1):186-8. [en.wikipedia.org] Mucocele This report highlights the importance of including frontal sinus mucocele in the differential diagnosis of spontaneous periorbital ecchymosis. [ncbi.nlm.nih.gov] Pulsating Exophthalmos Severe periorbital ecchymosis and edema were present in both eyes. Extraocular movements were limited due to soft tissue swelling. [healio.com]
