Circumorbital Hematoma (Black Eye): Causes, Symptoms & Management

A circumorbital (periorbital) hematoma is blood accumulation in the soft tissues surrounding the eye, typically from trauma.

Causes

• Blunt facial trauma (assault, fall, sports injury)
• Surgical procedures (blepharoplasty, sinus surgery, facelift)
• Facial injectables (filler, Botox) – vascular injury
• Basilar skull fracture (raccoon eyes – bilateral, delayed)

Symptoms

• Swelling, ecchymosis (bruising), discoloration progression (red→purple→green→yellow)
• Pain, tenderness
• Difficulty opening eye
• Visual disturbances (blurry, double vision)
• Headache

Management

• Ice packs (first 24-48 hrs)
• Analgesics (NSAIDs, acetaminophen)
• Head elevation
• Ophthalmologic exam if vision changes, globe injury suspected, or no improvement
• Surgical drainage rarely needed (compartment syndrome, expanding hematoma)

Most resolve spontaneously in 2-3 weeks.