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Traumatic Black Eye

Should probably get those raccoon eyes checked out.

Have you ever wondered why your most hated movie villains walk around with dark circles under their eyes? Did they have a late night plotting world domination? Do they all carry a gene for periorbital hyperpigmentation? Do they suffer from a condition like primary amyloidosis? Are the undereye circles the consequence of a nose job gone wrong? No. Their raccoon eyes are a sign of traumatic whooping by your favorite movie hero. That’s right, Darth Vader’s undereye circles- a clear sign of a basilar skull fracture sustained after his beating by Ben Kanobi. Regan MacNeil has the sniffles? Nah, that’s probably cerebral spinal fluid leakage in the context of her bilateral periorbital bruises. 

Not convinced? A 2014 study concluded that 68% of all patients with a black eye after a minor head injury had an underlying facial fracture. Major head trauma with bruising involving both eyes is a different ball game. Raccoon eyes in the setting of major trauma, has a positive predictive value of 85% for basilar skull fracture. How is it possible, you may wonder, that those super villains are still walking around with a skull fracture? It’s possible. While all folks with raccoon eyes following head trauma should be evaluated and followed closely, not all fractures require surgical intervention. 

So the next time you take a look at your most hated movie villains, know that the dark rings around their eyes are a sure sign that something ain’t right on the inside.


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