Orbital hematoma is most commonly described as which visual sign?

• A. Blunt trauma causing eyelid swelling
• B. Subconjunctival hemorrhage
• C. Bleeding into the anterior chamber
• D. Black eye

Answer: (D)

Bleeding into the tissues around the eye causes periorbital bruising and swelling, which patients and clinicians commonly describe as a black eye. This bruising arises when blood collects in the soft tissues of the orbit and surrounding eyelids, giving that dark, bluish-black discoloration.

Subconjunctival hemorrhage would appear as a bright red patch on the sclera, not around the eye, so it’s a superficial eye surface bleed rather than an orbital bruise. Bleeding into the anterior chamber (hyphema) involves the inside of the eye and changes vision, not external bruising. Eyelid swelling alone reflects edema without the characteristic dark periorbital discoloration. Thus, the classic external sign associated with orbital hematoma is a black eye.