What Causes A Black Eye?

Bernie Sanders and Arod recently seen with black eyes

Well it depends on if you’re asking about mechanism or the pathophysiology underlying the appearance of a black eye. Regarding the latter, a black eye is simply a bruise of the skin the near the eye. And a bruise is simply the result of an impact or trauma that causes rupture of underlying blood vessels in the skin. This, in turn, can lead to a collection of blood under the skin, or a hematoma. Eyelid skin and skin around the eye and orbit is very fragile and thin, so even minor trauma can sometimes result in a dramatic appearance of a black eye.

Regarding mechanism, trauma (either intentional or inadvertent) is the most common cause. The current news cycle reminds us of this…with stories of Bernie Sanders sustaining a black eye following a periocular trauma sustained from hitting the edge of a shower door, to the more drama-laden reports of Alex Rodriquez (Arod) getting a black eye from new fiance Jennifer Lopez (J Lo) after reports of a cheating scandal. Two pretty timely examples of black eyes related to both accidental and perhaps intentional trauma.

Another common cause of a periocular hematoma is post-surgical. When an eye surgeon performs even minor eyelid procedures it is not uncommon for a rather large bruise (periocular hematoma) to develop following the injection of just a small amount of numbing medicine in the eyelid skin. It’s also not uncommon for eye doctors to see black eyes form under the eye after surgery performed on the upper eyelids. Being on blood thinners can cause the hematoma to become larger. Invariably black eyes will get better on their own over the coming days and weeks. Ice can help limit the formation of a black eye by serving to constrict the local blood vessels that were initially ruptured.