Black Eye

What is a black eye?

A black eye, sometimes called a "shiner," is a bruise around the eye. When an object strikes the eye, the force of the impact breaks delicate blood vessels in the eyelids and surrounding tissues. Blood collects under the skin, and causes black or blue discoloration in the eyelids and around the eye socket. Because the skin around the eye is relatively thin and transparent compared to skin in other parts of the body, the black and blue color of a bruised eye may seem darker and more intense than bruises elsewhere. 

Although many people associate black eyes with fighting and violence, only about 15% of eye injuries are caused by violent assaults. Most black eyes happen by accident — during contact sports, at work, in a car crash or during home repair. Men get about four times more eye injuries than women do, and the average patient is approximately 30 years old. The source of the injury is usually a blunt object — a baseball, a hammer, a rock or a piece of lumber — and the most frequent place of injury is the home. At one time, it was also common for eye injuries to occur in motor vehicle accidents, usually when a victim's face struck the dashboard. However, the number of eye injuries caused by car crashes has decreased significantly because of airbags and the mandatory use of seat belts. 

Almost 2.5 million traumatic eye injuries occur each year in the United States. Most black eyes are superficial injuries that don't cause any permanent damage to the eye or to the tissues around it. When vision changes after a blow to the eye, it is a warning sign that the injury may be more than a simple bruise. The force of the blow may have fractured the delicate bones that form the eye socket, or the structure of the eye itself may be damaged.  

Symptoms of a black eye

A black eye causes swelling and black-and-blue discoloration of the eyelids and soft tissues around the eye.  

Sometimes, trauma that results in a black eye also causes small areas of bleeding on the white of the eye and on the inner lining of the eyelids. If you have bright-red or dark-red discoloration of your eyeball, you have another problem. This discoloration most likely is caused by a condition called a subconjunctival hemorrhage, which means a small blood vessel in the eye breaks and bleeds. This bleeding can be caused by trauma or by retching or vomiting. Like a black eye, the color change from a subconjunctival hemorrhage typically goes away slowly on its own, and the condition does not need any treatment. 

Diagnosing a black eye

You usually can diagnose a black eye yourself.

Expected duration of a black eye

Most of the swelling and discoloration go away within seven to 10 days after injury. The color of the skin around the eye will change over the course of recovery, typically showing green and yellow tones as the blood ages and is cleared from the tissue.

Preventing a black eye

Almost all eye injuries can be prevented. To decrease your risk of eye injuries: 

• Use appropriate protective eyewear at work. Studies have shown that face shields, goggles and other protective eyewear can reduce the risk of work-related eye injuries by more than 90%. 
• If you are an athlete, ask an experienced ophthalmologist, optometrist or optician for help in selecting protective eyewear that is appropriate for your sport. Baseball and basketball cause the greatest number of eye injuries. When a baseball or basketball strikes the eye, there is a risk of more serious trauma, including fractures of the eye socket. 
• Boxing is a common cause of black eyes The American Academy of Pediatrics opposes the sport of boxing for young people. 
• Always "buckle up" when you ride in a car. Seat belts and shoulder harnesses help to protect your eyes, facial bones and upper body from dashboard impacts and other injuries, even if your car is equipped with airbags. 
• For youth who play baseball, eye injuries can be reduced by using face masks and safety balls, which are balls that cause less injury when they strike a person. Safety balls include rubber balls, tennis balls and special "reduced-impact" balls that have a softer core. 

Treating a black eye

If you have a black eye, apply cold compresses (such as an ice bag or cool, damp cloth) to the injured eye for at least 15 minutes immediately after your injury to help reduce pain, swelling and discoloration. 

When to call a professional

Most black eyes are no more dangerous than a simple bruise on your arm or leg. There are times, however, when a black eye can be a sign of a more serious problem, such as a fracture of the eye socket or an injury to the inside of the eye. Call your doctor immediately if your black eye is accompanied by any of the following symptoms: 

• Decreased vision, blurry vision or double vision 
• Difficulty turning the eye in any direction (looking up, down, right or left) 
• Flashing lights or "floaters" (spots seen by one eye that travel with your field of view as you move your eyes) 
• "Bulging" of the injured eye out of its socket or an appearance that the eye has "sunken in" 
• Numbness in your cheek or upper teeth on the same side as the injured eye, which can be a sign of nerve damage related to a fracture of the eye socket 
• A cut on your eyelid or on the inside surface of your eye  

Prognosis

The prognosis for an uncomplicated black eye is good as it typically heals completely within a week or two. 

Additional info

National Eye Institute
https://www.nei.nih.gov/

National Institute of Environmental Health Sciences (NIEHS)
https://www.niehs.nih.gov/

American Academy of Ophthalmology
https://www.aao.org/

National Institute for Occupational Safety and Health
https://www.cdc.gov/niosh/

American Academy of Pediatrics (AAP)
https://www.aap.org/