A case of bilateral peri orbital ecchymosis without any identifiablepathology,which subsided on its own, in due course.

C, Vijayalakshim

Kumaran, Raghu

Ramamoorthy, Muthukumar

English

Otolaryngology online journal

                                                  
 
 
 
Volume 2 No2                                              ISSN 2250- 0359 
 
PANDA FACIES 
AUTHORS: PROF.DR.R.MUTHUKUMAR MS, DLO, DNB, 
                    DR.C.VIJAYALAKSHMI DLO II YR 
                   DR.RAGHUKUMARAN DLO II YR 
INSTITUTION: MADRAS MEDICAL COLLEGE 
ABSTRACT:   A case of bilateral peri orbital ecchymosis without any identifiable 
pathology,which subsided on its own, in due course. 
   
CASE STUDY:                                                                                        
          Thulasi, aged 42 yrs, home maker, met with a road traffic accident. While attempting 
to cross the road,  she was hit by a city bus on her side. Initially, she was taken to a nearby 
private hospital, where she was given first aid. Since it was a medicolegal case, she was 
referred to Govt. Kilpauk Medical Hospital. There she was given neuro clearance and then 
referred to RajivGandhi Govt. General Hospital for ENT opinion regarding epistaxis through 
her right nostril.             On the first day of admission, she had a central forehead haematoma 4x4cm, a 
lacerated wound over the root of the nose and an abrasion over the right ala and 
immediately below the nose. There was no AN/PN bleed. On the second day, she 
complained of giddiness. On the third day of admission, she developed purplish black 
discolouration around both eyes, with the forehead haematoma slightly increased in its size. 
 
 
 
 
              3
rd day of admission                                              5
th day 
 
                       7
th day                                                              10
th day 
 
                All necessary investigations and specialists opinion obtained. No abnormality could 
be detected. She was treated with antibiotics and supportive measures. In due course of 
time, the discolouration faded away. She was discharged on the tenth day. She was on 
regular follow up. She did not develop any post traumatic complications. 
CASE DISCUSSION: PANDA FACIES: 
 SYN: Panda eyes(UK), Raccoon eyes(US), Peri orbital ecchymosis, Black eyes 
Panda, a bear(1), native of central-western and south western China(2). It is easily 
recognized by its large, distinctive black patches around the eyes, over the ears and across 
its round body. 
  
 
 
 
                             PANDA                                                        RACCOON 
 
 
Raccoon, a mammal, is a native of NorthAmerica(3). Its most characteristic feature is area of 
black fur around the eyes, which contrasts sharply with the surrounding white face 
colouring. 
Black eyes(4) are mostly due to uncomplicated facial contusions. 
CAUSES: 
  Direct trauma to eyes and surrounding tissues. 
  Skull base fractures (most common). 
  Le Fort fractures, NEO Injuries. 
  Iatrogenic- Rhinoplasty, Craniotomy. 
  Certain malignancies(5). 
  Trigeminal autonomic cephalgia.   Amyloidosis. 
  Neuroblastoma(6). 
  Vigorous sneezing, coughing. 
  Chronic cocaine usuage. 
  Child abuse. 
Cases Reported: 
   A 9month old girl with raccoon eyes was investigated and found to have 
neuroblastoma(7) 
  A 22yr male, suffereing from dengue haemorrhagic fever was found to have 
bilateral peri orbital ecchymosis(8). 
  
REFERENCES: 
       1.Bram, Leon (1986), Funk and Wagnalis new encyclopedia vol 20, p119 
       2.global species programme- Giant Panda 
       3. Zeveloff , p1. 
       4. Buttaravoli and Stair: Common simple emergencies ,2.01 
       5. EMT Prehospital care 4
th edition 
       6. Gumus k  (2007). Int ophthal 27(6):379-81 
       7.The new England journal of medicine – july 2003  
       8. The Indian journal of ophthalmology- may-jun 2009                                             
 
 
 
 

PANDA FACIES

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