Black Eye from an Eye Injury

Dr. Russel Lazarus, July 28, 2021

Every year, eye injuries impact up to 13 in 1000 people.

A common eye injury known as a ‘Black Eye’ or a shiner, is a bruise that forms around the eye.

What is a black eye?

The black eye appearance is most often caused by a blunt blow to the face surrounding the eye, the eye socket or eyes. 

After the blunt force injury, blood vessels burst and collect under the skin, especially in the area of the lower lid, due to the force of the blow. Since the skin around the eye is thin, it’s easy to see the ruptured vessels – which produces the dark red or black color.

What causes a black eye?

A black eye usually results from a head or facial injury that produces bleeding beneath the skin. Blood seeps into the surrounding tissue when the small blood vessels beneath the skin, known as capillaries, rupture. This is what produces the bruising or discoloration.

Although most black eyes aren’t significant, they can occasionally signal a medical emergency, such as a skull fracture or fractured facial bones.

Some facial surgical treatments, such as nose surgery or a facelift, can result in black eyes. Blood that collects under the eyes due to a fracture in the base of the skull is referred to as “raccoon eyes.”

The black-and-blue tint of bruises around the eyes changes to yellow or green after a few days, because the blood beneath the skin breaks down and is reabsorbed into the surrounding tissues. However, the reabsorption of the blood can take up to two weeks for the tissues to return to their normal color, depending on the amount of blood that has collected under the skin.

Signs and symptoms of a black eye

Very soon after the injury, the eyelids and surrounding soft tissues swell and turn purplish-red to black.

A subconjunctival hemorrhage, or minor rupture in one of the blood vessels beneath the conjunctiva, can cause the white of the eye to turn bright red. The tissues may swell considerably and the area around the bruising may be discolored.

The most signs and symptoms of a black eye may include:

  • Dark red-purple coloration under the skin around the eye
  • Blood spots or pooling on the sclera (the white of the eye)
  • Swelling of eyelids or tissue adjacent to the eyes
  • Blurry vision
  • Double vision
  • Flashes of light
  • Showers of black spots
  • Difficulty opening or moving the eye
  • Pain around the eye
  • Numbness on the injured side of the face
  • Loss of consciousness, nausea, vomiting or disorientation
  • Affected eye appears sunk into its socket

SEE RELATED: What to do for a Black Eye?

Consult an eye doctor near you if you’ve experienced a black eye and any of the above symptoms, as they can signal an eye emergency.

Find an eye doctor near you

Complications of a black eye

A black eye is usually a mild condition that only requires application of cold packs of ice or something softer such as frozen steak or vegetables.

Severe injuries, particularly physical damage to the eye, can lead to sight-threatening problems.

If any of the following are noticed, urgent medical care is required.

  1. Uveitis

Blunt trauma to the eye can cause internal damage to eye, such as traumatic uveitis and iritis (iritis is a form of uveitis). Iritis usually only affects one eye.

The first sign of uveitis or iritis could be a black eye, but then the signs below could appear;

  • Small or irregularly shaped pupil
  • Blurred vision
  • Floating spots before the eyes
  • Pain that increases with exposure to bright light
  • Reddened eye, especially around the iris

2. Hyphema

    This is a collection of blood inside the eye, in the front (anterior) chamber of the eye, which indicates damage to the eye’s internal tissues.

    The amount of blood may be too little to notice with the naked eye, or it may completely fill the front of the eye.

    Hyphema requires urgent medical attention.

    3. Glaucoma

    Glaucoma is increased pressure inside the eye and may also be a result from blunt trauma to the eye, the increased pressure can occur immediately or even many years later.

    The force of the trauma might produce internal bleeding, resulting in a rise in eye pressure and permanent damage to the optic nerve.

    Even many years after the injury, scar tissue inside the eye can develop causing a slow rise in eye pressure and delayed-onset glaucoma might develop.

    Glaucoma can cause permanent vision loss, known as ‘Tunnel Vision’.

    4. Orbital floor fracture

    This is also known as a blowout fracture and may occur as a result of a forceful blunt trauma to the eye.

    The force of the blow pushes the eyeball farther into the eye socket, breaking the eye socket’s very thin bone walls. The optic nerve and the muscles that move the eye can be pinched (entrapped) as a result.

    An orbital floor fracture can cause double vision or loss of vision which needs urgent medical care.

    5. Retinal detachment

    Detachment of the retina can result in permanent vision loss.

    Trauma to the eye can cause the retina, which lines the back of the eyeball, to be lifted or pulled out of its usual position, causing the detachment.

    Flashing lights, partial or complete vision loss in the eye, and spots/floaters in the field of vision are all symptoms that must be treated immediately.

    Treating a black eye

    Ice, rest, and pain medication are the most commonly used to treat a black eyes caused by a low force eye injury.

    However, If you experience any vision changes or persistent pain, you should schedule an appointment with your doctor.

    If the bruising is accompanied by swelling and pain, use a cold compress for 10-20 minutes, then remove it for a few minutes before reapplying.

    Arnica is a good herbal treatment for swelling reduction. Vitamins C and K can assist in the healing process and help to minimize swelling.

    As the leaked blood is reabsorbed, a black eye, like any other bruise, will eventually heal and the discoloration will fade to yellow. A black eye can last anywhere from one to two weeks, as blood is slowly absorbed back into your skin.

    LEARN MORE: Guide to Eye Health

    If you’ve suffered a blunt force injury causing a black eye, contact an eye doctor near you. 

    A black eye needs to be examined by an eye doctor – it might only need a frozen pack of peas or could be a serious sight threatening eye injury.