A black eye is a facial injury characterized by bruising and swelling around the eye. Although the name suggests an eye injury, a black eye usually results because of an injury to the face. The name refers to the color of the bruising. Most black eyes aren’t serious, although if there is bleeding within the eye, the injury can be very serous. The most common symptoms of a black eye are pain and swelling. At first, the swelling and discoloration may be mild. The eye will be slightly reddened before progressing to a darker shade, such as black, green, yellow, or deep violet. As the discoloration worsens, the swelling will increase. There may also be headaches but usually because of the injury to the head. Blood on the surface of the eye itself, an inability to move the eye, loss of sight, and double vision are signs of a more serious injury.
The most common cause of a black eye is a blow to the nose, cheek, or eye. One or both eyes may be affected depending on where the blow lands. Trauma to the nose, which can cause fluid to gather in the eyelids loose tissue, can cause both eyes to swell. Black eyes are very common in sports, particularly hockey. A stick or puck to the face can be a significant blow and result in a black eye among other injuries. Black eyes are also common injuries among mixed martial artists and boxers because of the constant blows to the face from punches or kicks. For non-athletes, certain types of head injuries can also cause the eyes to blacken and swell. Surgical procedures to the face, such as nose surgery, jaw surgery, or a facelift can result in a black eye. Other causes of swelling around the eye include dental infections, cellulitis, bug bites, and allergic reactions. These usually do not cause discoloration, however, just swelling.
Almost all black eyes can be treated at home. Use gentle pressure and place an ice pack on the area around the eye. Avoid pressing on the eye itself, however, and make sure the ice pack is wrapped in a something like a thin towel to prevent skin damage like frostbite. You should apply the ice pack as soon as possible after the injury occurs to reduce swelling. Ice constricts the blood vessels, cools and numbs the area, and decreases fluid accumulation, all of which help decrease swelling. Continue to apply the ice pack for about 20 minutes each time, several times per day, for the next 24-48 hours. Keep an eye out for evidence of blood within the colored and white parts of the eye. If blood can be seen, it is important to seek immediate medical attention. You should also seek medical attention if you have vision problems. Your doctor may refer you to an ophthalmologist for an actual eye injury or a plastic surgeon to fix any serious facial lacerations.
With proper treatment, swelling should go down after only a few days, while any discoloration may take a week or so to disappear. For athletes, return to play should be almost immediate, as long as there isn’t further damage to the eye, nose, or face. While a black eye may be uncomfortable, it shouldn’t affect any other part of the body. For more complicated injuries however, you should follow up constantly with the specialist you are seeing. If your symptoms or swelling gets worse, see your doctor immediately. To prevent a black eye, make sure you are wearing appropriate protective equipment while playing sports. For hockey players, this means either a full cage or half visor. For non-athletes, make sure to wear safety goggles while working, and wear seat belts and helmets when driving a car or riding a bike. Johns Hopkins Medicine has more information about black eyes and various treatment methods.