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.

[Heogog53]

I'm wondering if the patient had been on any NSAIDS or ASA too close to the time of her surgery, or if some chemo/radiation treatments had made her skin, especially around the eyes, extremely sensitive and friable, very likely to bruise and or tear? Another possibility is that she has/had some type of either dermatologic or ophthalmologic issue that she forgot to mention to anyone.

Since she wasn't prone at any time during the case and she had symmetrical black eyes, it's hard for me to buy into the idea that the assistant's elbow ended up in the same place twice on each side.....

or that the padding from various prone equipment could have interfered with her.

Was she perhaps a redhead or extremely lightly complected? THAT sounds stereotypical, but if she had truly fair skin, that may have contributed to it.

Overall, very odd case.

[muffin7]

That does not that sound stereotypical.

[nurseaboveboard]

No to all of the above, and I have no idea what anesthesia thought, but other docs were surprised.

[elgin1962]

I woke up after undergoing surgery to remove my gallbladder with bilateral "black" eyes several years ago. The bruising was so severe, one might have thought I'd been punched in the face. It was determined that the taping done by the anesthesiologist to protect my eyes and then the subsequent removal of the tape was the reason for the bruising in that delicate area. I have since had surgery in the prone position for several hours and although woke up with puffy eyes, never before or since had bruising of this severity. I believe that is the answer to your question and that there is no mystery here concerning your patient's black eyes.

[RNiel]

I can't remember exactly how it happened, it was a long time ago, but I saw a CRNA's hand slip off of a Laryngoscope during a difficult intubation and hit the patient on the nose. I've never saw it before or since. It was strange. I don't know if the patient had any bruising, but I could see how s/he would have.

[Bearzrul]

Hi

Just thinking, during the procedure, pt patient may have been leaned on and no one realized it. I've seen patient's with lower extremity bruises from resident's holding retraction and using the body for leverage.