Raccoon Eyes

Raccoon Eyes

Raccoon eye/eyes (also known in the UK as panda eyes) or periorbital ecchymosis is a sign of basal skull fracture, a craniotomy that ruptured the meninges, or (rarely) certain cancers. Bilateral subconjunctival 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 layman's 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 may not appear until up 2–3 days after the injury. It is recommended that the patient not blow their nose, cough vigorously, or strain to prevent further tearing of the meninges.

Racoon eyes may be bilateral or unilateral. If bilateral, it is highly suggestive of basilar skull fracture, with a positive predictive value of 85%. Most often associated with fractures of the anterior cranial fossa.

Raccoon eyes may also be a sign of disseminated neuroblastoma or of amyloidosis (multiple myeloma). It can also be a side effect of using cocaine.

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