Periorbital Hyperpigmentation Treatment, Prevention

Periorbital Hyperpigmentation Treatment/Black Eye is bruising around the eye commonly due to an injury to the face rather than to the eye. The name is given due to the color of bruising. The so-called black eye is caused by bleeding beneath the skin and around the eye. Sometimes a black eye can worsen if not referred to a doctor if not resolved after a few months, indicating a more extensive injury – potentially even a skull fracture?, particularly if the area around both eyes has bruised (raccoon eyes), or if there has been a prior head injury.

Causes of Black Eye

Pigmentation under the eyes is associated with dermal deposition of melanin. Dermal melanin deposition is often due to post-inflammatorypigmentation, which may follow:

• Sun exposure
• Atopic dermatitis
• Contact dermatitis
• Rubbing or scratching the eyes.
• Increased pigmentation (melanin)
• A blow to the nose often causes both eyes to swell because the swelling? from the nasal injury causes fluid to collect in the loose tissues of the eyelids.
• Surgical procedures to the face, such as a face lift, jaw surgery, or nose surgery, can cause black eyes.
• A certain type of head injury, called a basilar skull fracture?, causes both eyes to swell and blacken. This condition is typically described as “raccoon’s eyes.”
• Other causes of swelling? around the eye include allergic reactions, insect bites, cellulitis (skin infection? around the eye), angioedema (a hereditary condition causing swelling, usually around both eyes), and dental infections. However, these conditions do not make the skin turn black and blue around the eye.
• Loss of fatty tissue in the eyelid or around the eye
• Bulging fat and muscle loss
• Puffy eyelids
• Thin, translucent skin
• Shadowing due to anatomic shape of the orbit

Loss of fatty tissue in the eyelid or around the eye (tear trough) is associated with

• Ageing
• Genetic factors
• Smoking.

Bulging or puffy eyelids may be due to systemic? conditions, particularly

• Thyroid? disease
• Dermatitis
• Hay fever? (allergy?).

Thin translucent skin is commonly observed with

• Age
• Genetic factors.

Shadowing is more noticeable at times, due to

• Fatigue? or lack of sleep
• Periorbital oedema (puffy eyelids)
• Dehydration? (sunken eyes).

Superficially located blood vessels and blood stasis may contribute to the darkened appearance.

Symptoms of Black Eye

• Bleeding from the eyeball (DO NOT apply pressure)
• Loss of consciousness (patient got knocked out)
• Double vision
• Loss of sight and/or fuzzy vision could occur
• Loss of consciousness
• Inability to move the eye or large swelling? around the eye
• Blood or clear fluid from the nose or the ears
• Blood on the surface of the eye itself or cuts on the eye itself
• Persistent pain? in the head or upper neck. সহজ বাংলা: মাথাব্যথা।" data-rx-term="headache" data-rx-definition="Headache means pain in the head or upper neck. সহজ বাংলা: মাথাব্যথা।">headache? or nausea?, or light sensitivity. সহজ বাংলা: বারবার হওয়া বিশেষ ধরনের মাথাব্যথা।" data-rx-term="migraine" data-rx-definition="Migraine is a recurring headache disorder often with throbbing pain, nausea, or light sensitivity. সহজ বাংলা: বারবার হওয়া বিশেষ ধরনের মাথাব্যথা।">migraine?
• Two black eyes (also known as “raccoon eyes” or “panda sign”)—especially if the injury was to a part of the head other than the face
• Confusion
• Loss of vision or blurred vision
• Vertigo (dizziness)
• Pain? around the eye
• Swelling? around the eye, which can be mild at first, then increasing later. Swelling may make it difficult to open the eye
• Discoloration (like a bruise) around the eye. The skin around the eye may be red at first, then grows darker, progressing to purple, yellow, green or black.

Regular black eye symptoms

• infection?, or irritation, often causing pain?, swelling?, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">Inflammation? around the eye; this may start out mild and then worsen, possibly making it difficult to open the eye
• Bruising, discoloration, and soreness around the eye; generally, the skin first appears red and then changes to dark purple, yellow, green or black
• Blurry vision
• Blood on the surface of the eyeball
• Inability to move the eye
• Vision Loss
• Double vision
• Blood or fluid coming out from your nose or ears
• Fainting
• Severe or constant headache
• Vomiting?

Diagnosis? of Black Eye

Diagnosis? of periorbital hyperpigmentation was done clinically and the patients were classified according to the classification proposed by Ranu et al.[rx] as follows:

• Constitutional – The presence of a curved band of brownish to black pigmentation on the skin of the lower eyelids approximating the shape of the orbital rim with frequent involvement of upper eyelids.
• Post inflammatory  – Presence of irregular patches of brownish or grey pigmentation on the skin on the upper, lower or both eyelids with features of lichenification, accentuation of skin creases, and eczematous papules or patches in the surrounding areas. Personal and/or family history of atopy may or may not be present.
• Vascular – Presence of allergy?, infection, or inflammation. সহজ বাংলা: চামড়া লাল হয়ে যাওয়া।" data-rx-term="erythema" data-rx-definition="Erythema means skin redness, often from irritation, allergy, infection, or inflammation. সহজ বাংলা: চামড়া লাল হয়ে যাওয়া।">erythema? predominantly involving the inner aspect of lower eyelids, with prominent capillaries or telangiectasia (capillaries) or the presence of bluish discoloration of the lower eyelid and visible bluish veins that becomes more prominent when the overlying skin is stretched. This type of dark circle appears to be due to a combination of transparency of the overlying skin and dermal vascularity.
• Shadow effect – Presence of a dark shadow under an overhanging tarsal muscle, eye bags, or the presence of a deep tear trough over the medial aspect of inferior orbital rim that disappear with direct lighting.
• Others  – POH from other causes including anemia?, hormonal disturbances, nutritional deficiencies, acanthosis nigricans, skin laxity, associated chronic? illness, habits, etc.

Grading of POH/ black eye was done in comparison to surrounding skin as follows

• 0 – skin colour comparable to other facial skin areas,
• 1 – faint pigmentation of infraorbital fold,
• 2 – pigmentation more pronounced,
• 3 – deep dark colour, all four lids involved,
• 4 – grade 3+ pigmentation spreading beyond infraorbital fold. Wood’s lamp[rx,rx,rx,rx] examination was done to determine whether pigmentation is epidermal or dermal.

Treatment of Black Eye

Treatment of dark circles under the eyes depends on its nature. General measures include

• Adequate sleep
• Smoking cessation
• Sleep with extra pillows to elevate the head and reduce eyelid swelling?
• Massage temporary swelling while applying a cold compress
• Cold compresses also minimise the appearance of prominent blood vessels
• Cosmetic camouflage
• Light-reflecting concealers (these are often yellow or gold in colour) covered by translucent face powder. These should be applied in the shadows, not on the puffy skin.

Medical treatments to reduce pigmentation can include:

• Protection from sun exposure using sunglasses
• Topical agents; however dermal pigmentation responds poorly, and eyelids are sensitive so the stronger products may irritate
• Chemical peels to reduce fine lines and surface pigmentation
• Laser or intense pulsed light (IPL) treatments.

Loss of tissue (hollowing) and tear trough can be managed by aesthetic medical and surgical procedures:

• Fillers – (dermal implants) eg hyaluronic acid injections or fat grafts
• Surgery to remove excess fat – muscle and skin (surgical blepharoplasty or laser eye-lifting procedure).
• Start with cold – Apply that bag of frozen peas, chilled spoon or some other method to lower the temperature of the area around the eye as soon as possible after the injury and frequently thereafter for the first 24 hours.
• Then switch to warm – After a day or two of applying cold packs, try gently applying warm (not hot) compresses to your black eye. This will increase blood flow to the area to facilitate healing.
• Gently massage – the area surrounding the bruise (not the black eye itself) in the days following the injury. This may help activate the lymphatic system near the bruise and speed up the healing process.
• Snack on pineapple – This tropical fruit contains a mixture of enzymes that reduce infection?, or irritation, often causing pain?, swelling?, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation? and speed healing, which may help your black eye go away faster.
• Load up on vitamin C – Though vitamin C may do more to reduce how easily you bruise (by strengthening blood vessels, reducing their tendency to leak after blunt trauma), it also may help speed the healing of your black eye.
• Try bilberry extract – Bilberry is a relative of the blueberry and cranberry, and it contains potent antioxidants that may help reduce or eliminate bruising by increasing the effectiveness of vitamin C and strengthening capillaries.

Prevention

A number of measures can reduce the likelihood of traumatic injury, including a black eye.

Here are some tips

• Rugs and carpets – Fix or place these to avoid wrinkles and slipping
• Other trip hazards – Keep the stairs and floor clear of cables, clutter, and other items, especially in areas where people walk
• Never put raw meat on a black eye – There is a first aid myth that putting a steak on a black eye will help it heal faster. It will not. In fact, putting raw meat on a black eye is more likely to cause an infection?.
• Never put pressure on the eyeball – Eyes are delicate and pressure can lead to serious permanent injury. There is a fluid inside the eyeball with the consistency of jelly. This fluid is called vitreous humor and it helps the eye maintain its shape. The shape of the eye is essential for proper function. Any pressure, even light pressure, on a ruptured eyeball can cause the loss of vitreous humor and permanent loss of vision.
• Ice works to decrease swelling – but there’s not really anything that can be done for the bruising. Time is the only treatment. Left alone, the discoloration of a black eye will eventually fade.
• Protective gear – People who participate in activities that increase the risk to the face, such as martial arts, boxing, and contact sports should use protective gear. Helmets are essential when cycling or riding a motorcycle.
• Goggles – These can help protect the eyes during activities such as gardening, woodwork, or metalwork.
• Stop any activity and apply ice wrapped in a thin cloth (or a cold compress or a bag of frozen vegetables) to the area around the eye.
• Avoid putting direct pressure on the eyeball itself.
• Keep the ice on the area for 15 minutes at a time every waking hour for the first 24 hours.
• Keep your head elevated while sleeping. Using two pillows may help reduce swelling throughout the night.
• Pain medications may help reduce swelling and inflammation and decrease pain but stay away from aspirin which may increase bleeding.
• Continue to apply ice several times a day until the swelling subsides.
• Continue to check for any warning signs of a serious head injury for up to 48 hours.
• Allow the eye to heal before returning to sports

References