This clinical sign is raccoon eyes (also called the raccoon sign or panda sign).
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Raccoon eyes refers to unilateral or bilateral progressive periorbital ecchymosis with edema, occurring without direct ocular trauma. The bruising results from blood tracking into the loose periorbital tissues, rather than injury to the eye itself.
It is most commonly associated with fractures of the anterior cranial fossa. Importantly, this sign is delayed, typically appearing 1–3 days after head injury, not immediately. When bilateral, it is highly predictive of an anterior skull base fracture.
A classic feature is sparing of the tarsal plate. Further spread of blood beyond the periorbital region is limited because the orbital septum inserts into the tarsal plate, acting as an anatomical barrier.
Dark bruising around both eyes.
No direct eye trauma.
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