Resident Manual of Trauma to the Face, Head and Neck

CHAPTER 3: Upper Facial Trauma

h. Periorbital Ecchymosis Periorbital ecchymosis (“raccoon eyes”) is a common indicator of ruptured blood vessels—usually the ethmoid arteries and/or the angular artery and vein near the medial canthus (Figure 3.18). It can also be suggestive of a basilar skull fracture, which must be ruled out through diagnostic imaging.

Figure 3.18 Bilateral periorbital ecchymoses.

i. Retrobulbar Hematoma Retrobulbar hematoma is a very serious condition, in which periglobal blood vessels have been ruptured and blood accumulates around or within the muscular cone. The patient will complain of pain, decreasing vision, and pressure, and may have nausea and vomiting. There will be obvious proptosis and a firm globe to gentle palpation, compared to the normal side. This is a true emergency. Ophthalmologic consultation is mandatory. However, owing to the laxity that generally occurs with a lateral splay- ing of the medial canthal tendons, there is a natural release to the intraorbital pressure caused by the expanding hematoma. Nevertheless, this will not last long, and intervention should be undertaken as soon as diagnosed. j. Epiphora Epiphora is usually due to tissue edema surrounding the medial eyelids. However, fractures and soft tissue injuries involving the lacrimal

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Resident Manual of Trauma to the Face, Head, and Neck