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Injury. 2014 Jan;45(1):203-5. doi: 10.1016/j.injury.2013.09.010. Epub 2013 Sep 20.

The clinical features of periorbital ecchymosis in a series of trauma patients.

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  • 1Department of Neurosurgery, Wake Forest Baptist Medical Center, Wake Forest University, United States.



Periorbital ecchymosis (PE) is caused by blood tracking along tissue plains into periorbital tissues, causing discoloration in the upper and lower eyelids. This clinical feature is most commonly associated with basal skull fractures. Our objective is to present the first patient series describing the clinical features associated with traumatically induced PE.


The authors retrospectively reviewed 36 consecutive cases of patients presenting to the emergency department with PE over a three-year period at St. Michael's Hospital in Toronto. Data were obtained using a standardised data acquisition template.


All patients presented to the emergency department with PE. The mean age in our series was 39 years (range 19-88 years), 31 patients were male. PE was associated with a variety of injuries including: 15 basal skull fractures, 9 soft tissue injuries without fractures, 8 convexity fractures, and 3 facial fractures. The other classic signs of basal skull fracture (Battle's sign, hemotympanum, cerebrospinal fluid otorrhea, cerebrospinal fluid rhinorrhea) were observed in 3, 7, 1, and 3 patients with PE, respectively. The most common clinical feature associated with PE was cranial nerve injury, observed in 10 patients. Surgical intervention was required in 8 patients. Five patients were discharged to a rehabilitation centre. No meningitis, cerebral abscess, encephalitis or deaths were observed.


Periorbital ecchymosis is a useful clinic sign that should alert the clinician to assess for skull fractures, intracranial haemorrhage, and cranial nerve injury. However, this series shows that PE can be associated with a variety of clinical features, is rarely accompanied by other classic signs of basal skull fracture, and most patients with PE do not have injuries severe enough to require surgical intervention or post-discharge rehabilitation.


Orbital fracture; Periorbital ecchymosis; Raccoon eyes; Skull base fracture; Trauma

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