29. Black eye

A 65-year-old woman presented for dental care with an obvious brown-black discoloration of her peri-ocular skin on one side, first noticed on awakening 5 days earlier. Extra-oral examination revealed a unilateral diffuse brushing, restricted to the upper and lower eyelid and malar skin (Figure 1), but with no serious eye involvement. No similar lesions were found in the skin of the face or in other parts of her body. Intra-oral examination revealed no tooth, bony or soft tissue abnormalities. The patient had no serious medical problems apart from a mild hypertension and a chronic depression, often exacerbated by domestic violence.

Traumatic haematoma inflicted by her alcoholic husband is the likely diagnosis. Older patients have fragile skin vessels which bleed easily with minor trauma and form petechiae or large ecchymoses on their hands, legs, or other traumatized sites. Patients on anticoagulant drugs or with blood diseases, such as leukaemia or thrombocytopenic purpura, often have a plethora of clinical or laboratory characteristics which were not seen in this patient.