Raccoon eyes

{{Short description|Bruising of the eye orbits, indicating skull fracture or internal bleeding}}

{{Infobox medical condition

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| synonyms = Panda eyes, periorbital ecchymosis

| image = Racoon_eyes_injury_with_csf_leak_csv_hariadhi.svg

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| caption = Bilateral raccoon eyes with CSF leak

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| field = Neurosurgery

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| causes = Le Fort 2 and 3 fracture

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File:Bilateral periorbital ecchymosis (raccoon eyes).jpg

Raccoon eyes, also known as panda eyes or periorbital ecchymosis, is a sign of basal skull fracture or subgaleal hematoma, a craniotomy that ruptured the meninges, or (rarely) certain cancers.{{cite journal | first = FA | last = Herbella |author2=Mudo M |author3=Delmonti C |author4=Braga FM |author5=Del Grande JC |date=December 2001 | title = 'Raccoon eyes' (periorbital haematoma) as a sign of skull base fracture | journal = Injury | volume = 32 | issue = 10 | pages = 745–47 | pmid = 11754879 | doi = 10.1016/S0020-1383(01)00144-9}}EMT Prehospital Care (4th Edition) Bilateral hemorrhage occurs when damage at the time of a facial fracture tears the meninges and causes the venous sinuses to bleed into the arachnoid villi and the cranial sinuses. In lay terms, blood from skull fracture seeps into the soft tissue around the eyes. Raccoon eyes may be accompanied by Battle's sign, an ecchymosis behind the ear. These signs may be the only sign of a skull fracture, as it may not show on an X-ray. They normally appear between 48 and 72 hours (2-3 days) after the injury.Handbook of Signs & Symptoms (Third Edition) It is recommended that the patient not blow their nose, cough vigorously, or strain, to prevent further tearing of the meninges.Nursing: Interpreting Signs and Symptoms

Raccoon eyes may be bilateral or unilateral.[http://bestpractice.bmj.com/best-practice/monograph/398/diagnosis/step-by-step.html "Skull fractures. Step-by-step diagnostic approach"]. Best Practice, BMJ. If unilateral, it is highly suggestive of basilar skull fracture, with a positive predictive value of 85%. They are most often associated with fractures of the anterior cranial fossa.{{Cite web|url=https://bestpractice.bmj.com/topics/en-gb/398/history-exam|title=BMJ Best Practice|website=bestpractice.bmj.com}}Visual Diagnosis in Emergency and Critical Care Medicine, Christopher P. Holstege, Alexander B. Baer, Jesse M. Pines, William J. Brady, p. 228

Raccoon eyes may also be a sign of disseminated neuroblastoma, amyloidosis, Kaposi’s sarcoma or multiple myeloma.{{cite journal |author=Gumus K |title=A child with raccoon eyes masquerading as trauma |journal=Int Ophthalmol |volume=27 |issue=6 |pages=379–81 |year=2007 |pmid=17534581 |doi=10.1007/s10792-007-9089-y|s2cid=5921 }} It also can be temporary result of rhinoplasty.{{Cite book |last=Steinbacher |first=Derek M. |url=https://books.google.com/books?id=g8-HDwAAQBAJ&dq=Raccoon+eyes+rhinoplasty&pg=PA605 |title=Aesthetic Orthognathic Surgery and Rhinoplasty |date=2019-05-21 |publisher=John Wiley & Sons |isbn=978-1-119-18697-7 |language=en}}

Depending on cause, raccoon eyes always require urgent consultation and management, whether surgical (facial fracture or post-craniotomy) or medical (neuroblastoma or amyloidosis).