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.[1][2] 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.[3] It is recommended that the patient not blow their nose, cough vigorously, or strain, to prevent further tearing of the meninges.[4]
Depending on cause, raccoon eyes always require urgent consultation and management, whether surgical (facial fracture or post-craniotomy) or medical (neuroblastoma or amyloidosis).
^Herbella, FA; Mudo M; Delmonti C; Braga FM; Del Grande JC (December 2001). "'Raccoon eyes' (periorbital haematoma) as a sign of skull base fracture". Injury. 32 (10): 745–47. doi:10.1016/S0020-1383(01)00144-9. PMID11754879.
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