Dear XXXXXXX

Thank you for your query.

1. Spontaneous Black Eyes without a cause is rare.
2. Does she have pain, fever or swelling?
3. Are there any visual problems? Is there blurring or double vision?
4. Is there any inability to move the eyes in any particular direction?
5. Is there any nasal bleeding or discharge? Is there any bleed in the eye itself?
6. Is there any history of unconsciousness?
7. Is there any history of a blow to the eyes or nose? or an assault / accident / fall (an orbital blow-out because the bony lamina between the eye and nose is extremely wafer thin)?
8. Is there any history of severe sneezing, headache or sinusitis?
9. Has a coagulogram been done?
10. Is the black eye all around (Racoon eyes) or only below the eyes? You may send a photo to YYYY@YYYY with 'Attn: Dr. Sumit Bhatti' in the subject line.

The face has loose tissue around the eyes and the collection of blood and inflammatory fluid would shift and drag tissue causing shifting pains.

Further discussion will be easier after you answer these questions,

Regards.

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1. Since you have answered in the negative for most of the causes and she has no visual problems, the causes may be narrowed down. Pain and swelling may signify a pre-septal (peri-orbital) cellulitis. Pain on moving eyes suggests that the infection or inflammation may be spreading to the post-septal compartment of the orbit and may result in orbital cellulitis.
2. Some causes are:
a) Local bruising,
b) Insect bites,
c) Spread via blood from adjacent sites such as sinuses or infected teeth or distant site, usually bacterial. (X-ray's may not pick up mild sinusitis).
d) Sleeping with eye make-up on
e) Lacrimal gland and duct infections, bacterial or viral.
3. As her condition is on both sides, and common causes have been ruled out, it is intriguing. It is now important to note the actual clinical examination findings of your local E.N.T. Specialist and the photograph. This may shed some light as to the cause of this condition.
4. If her condition is improving, you should supplement antibiotics and anti-inflammatory medication, local ointment and fomentation. Hemorrhage (bleeding) under the skin will change color and slowly disappear as the blood and pigments are absorbed back into the body. There are creams to hasten this but are not to be applied to the delicate skin around the eyes.
5. If her condition does not improve or worsens, for example if she has restricted eye movements or visual problems, you must insist on a USG Orbit, a CT Orbit or an MRI Orbit. This is because orbital cellulitis spreads quickly and requires aggressive treatment.

You should also get an Ophthalmologist's opinion and get her coagulogram and full blood count done.

I hope she has some minor cause and at her age, she should recover soon.

Regards.

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