Almost everyone has had a black eye and thought nothing of it. A blow to the face or head bruises the skin around the eye bones (orbits), causing blood and other fluids to collect in the tissues around them. The signature discoloration and swelling give the injury its name.

The skin around the eye is very loose, with mostly fat underneath, making it one of the first places to swell in even minor face and head injuries. Consequently, toolbox talks focus on preventing foreign objects from entering the eye, and what first aid to administer when they do. Few see danger in a black eye.

Ophthalmologists agree that foreign objects in the eye may present fewer vision problems than black eyes because people seek medical attention for the former but assume black eyes are harmless. A black eye suffered on the job usually results from a hefty blow. Victims attribute a headache, some blurry vision, or difficulty opening the eye to side effects of that trauma, yet they can be symptoms of more serious vision problems.

Better safe than sorry

Employers should stress that workers with job-related black eyes visit an ophthalmologist (an eye specialist who is a medical doctor) to rule out vision-threatening injury. A blow severe enough to cause a black eye can fracture the orbit bone. In addition, the floor of the orbit can blow out, trapping an eye muscle.

“A common complaint of an orbital blowout fracture is vertical double vision,” says optometric physician Dr. Troy L. Bedinghaus of Lakewood Ranch, Fla. “Furthermore, blood and fluid seeping through the broken orbit can cause facial congestion or fullness. Never delay medical evaluation of eye trauma, as serious eye conditions can worsen if not treated early. For example, recurring bleeding in the eye can reduce vision and damage the cornea. In severe cases, glaucoma can occur.”

Supervisors should call 911 or take the worker to an emergency room if there is:

• Bleeding from the eyeball (do not apply pressure)

• Blood or clear fluids draining from the nose or ears

• Loss of consciousness

• Two black eyes (especially if the injury was to a head area other than the face)

• Confusion

• Loss of vision or blurred vision

• Vertigo (dizziness)

• Broken facial bones or teeth

• Change in behavior

• Vomiting

• Inability to walk after the injury

• Lacerations to the face or head

“People taking blood thinners, such as warfarin (Coumadin), or those with a history of bleeding problems, such as hemophilia, should also go to a hospital emergency department,” says Bedinghaus. “Do not give the person aspirin or ibuprofen for pain, as that can increase bleeding. Administer acetaminophen.”

The immediate treatment for a black eye is ice and rest, a combination often ignored in the rush to complete projects. Ice helps reduce swelling by constricting blood vessels and reducing fluid accumulation. Caregivers should apply ice or a cold compress to the eye for 15 to 20 minutes every hour for the first 24 hours while the person is awake.

“Never press on the eye to prevent further bleeding or swelling,” says Bedinghaus. “To protect the skin, wrap the ice in a cloth or use a commercial ice pack. If you have neither, a bag of frozen peas wrapped in a shirt works great.”

Another recommended way to reduce swelling is to elevate the head of the bed 3 inches or sleep on an extra pillow. “Forget the adage about putting raw steak on a black eye,” says Bedinghaus. “No scientific evidence supports this claim, and you run the risk of a dangerous eye infection caused by organisms living on the meat.”

Back home

Workers who refuse medical attention should know that symptoms can develop hours later. Doctors recommend an immediate, in-depth evaluation if the person shows:

• Signs of infection (increased redness, warmth and puslike drainage)

• Persistent eye pain

• Changes in vision

• Visible abnormality of the eyeball

• Visible bleeding on the white part (sclera) of the eye, especially near the cornea

• Swelling that does not improve after a few days

“Avoid athletic or other possibly injurious activities until after the eye heals in one to two weeks,” says Bedinghaus. “Applying ice in the first 24 hours after the injury has the most significant effect on the speed with which the injury heals.”