In lay terms, blood from skull fracture seeps into the soft tissue around the eyes.

[3] It is recommended that the patient not blow their nose, cough vigorously, or strain, to prevent further tearing of the meninges.

[5] If unilateral, it is highly suggestive of basilar skull fracture, with a positive predictive value of 85%.

[6][7] Raccoon eyes may also be a sign of disseminated neuroblastoma, amyloidosis, Kaposi’s sarcoma or multiple myeloma.

[9] Depending on cause, raccoon eyes always require urgent consultation and management, whether surgical (facial fracture or post-craniotomy) or medical (neuroblastoma or amyloidosis).