Why Black Eyes?

[nurseaboveboard]

Hello nurses. Recently a patient returned from the OR with black eyes following a procedure no where near the face. Don't want to give too much detail here you understand. Most of the bruising/bleeding was on the upper eyelids, and also bleeding ran under the skin alongside the nose, puffing out like a little bag of blood/hematoma. This was a complete surprise to the patient/floor nurses/docs. PT/PTT WNL. No HX bleeding disorders. Nobody was able to give a plausible reason. What if any thoughts can you offer re this. Perplexing.

[#1rnstudent]

Does it have anything to do with the way the patient was positioned? If they were prone then maybe gravity had something to do with it? :)

[linda2097]

If the patient was in the prone position during surgery, they might have incorrectly padded the face.

[maeyken]

During surgery they usually tape the eyes shut to prevent damage. Did your patient have really delicate skin? It would be a very rare occurrence, but it's possible.

Also like others have mentioned- prone positioning could do it.

[morte, LPN, LVN]

if this was cranial surgery....i would think "coons" eyes, ie bleed......god forbid, did he fall intraoperatively? and hit his head?

[fracturenurse]

Can u give us a clue on position? I'm thinking prone. I know a horror story about a patient going blind from incorrect positioning while in prone.

[ewattsjt]

sounds like prone to me too. even if the pt is positioned correctly but the case is a real long one like multilevel spine surgery, the duration of being prone for so long can do that.

[Scrubby]

I agree with everyone here, sounds like being in the prone position for a long time, no padding/support around the face.

Though even with the cushioned padding our patients still have reddened marks on their face, torso etc. I've never seen bleeding or heavy bruising though.

[nurseaboveboard]

Hello everyone and thank you for your posts. No, the patient would not have been prone and the surgery was below the neck. Any other ideas? Is it OK to tell the procedure here?

[#1rnstudent]

And the patient was not in trendelenburg position then? Hmmm... hard to say. I need more info. :\

[nurseaboveboard]

The procedure was simple mastectomy w/reconstruction, so I can't imagine that positioning had much to do with it? What exactly is done with the eyes in OR? Also, could it be from excessive gag/coughing reflex in recovery, trying to cough out the ET tube? Thanks everyone.

[maeyken]

The one thing I thought of that I mentioned earlier, was that anesthesia usually tapes the eyes shut during the case. Just today we had a pt get a small hematoma in the corner of her eye from the tape coming off. (I'd never seen it before today, though.) So that could be a possibility.

I've never seen a patient get a black eye from the coughing, but there's always a first!