When we talk about any injury near the eye, the immediate damage is the first thing most people think of. 

The black eye, the cut, the bruise, the periocular trauma in general. That’s any injury happening around the eye area, meaning from eyelids and brows down to the cheekbone. As any medical professional knows, the priority is always to treat the initial injury before anything else, but the true story? 

That can unfold much later. 

The problem with secondary complications in such cases is that they’re VERY easy to miss, and if they ARE present, they could only start being a noticeable problem in a week or two.

In this article, we’ll go through the kinds of complications that can sneak up once the swelling is gone and everyone starts to expect things to go back to normal. 

Why Secondary Complications Develop

When people think about eyes, they focus on the actual sight organ; they don’t give the area around the actual organ much thought. This mostly has to do with how simple it looks. But in reality, it’s quite the opposite.

The area around the eye is packed with numerous tiny bones, it’s filled with muscles that control every blink, it’s filled with numerous sensitive nerves and delicate drainage systems (for tears), plus there’s a vast network of blood vessels there.

In short, the anatomy of the area around the eye is quite intricate. Because it’s so intricate, it’s also susceptible to having issues after any procedure to the eye.

An injury doesn’t affect a single isolated thing. In fact, it can send a shockwave through this entire system and disrupt lots of connections and functions. 

Right after an injury has happened, the body’s immediate response is swelling, bruising, and bleeding. It goes without saying that this is all serious, but it can hide even more issues. 

Everyone will see the puffiness and the black eye, but what’s underneath that? 

A fragmented bone could be pressing on a nerve, or a canal that’s meant to drain fluid could be blocked. The initial trauma creates almost a camouflage and allows deeper problems to develop without anyone knowing about them. 

So what causes those secondary issues? What is it that decides whether you’ll have any problems or not?

Well, a lot depends on the type of injury suffered. A high-force impact (e.g., a punch or one from a car accident) might cause hidden fractures and/or tissue tears. And the issue here might only start a week or two later.

But if the injury has also introduced any contaminants (e.g., a scratch from a dirty object, a dirty projectile such as a pebble, etc.), the infection mightn’t be visible until days later.

Interestingly, even the body’s own healing process can make matters worse because, when scar tissue starts to form, it can pull on things that shouldn’t be pulled. 

Here’s a quick example:

Eye injuries caused by dog attacks are often a mixture of crushing/rearing forces and lots of contaminants. This is because if bitten, dog saliva has lots of bacteria that might cause an infection to happen, plus the teeth might also be filthy. A scratching attack will be as difficult to deal with as simple for the fact that dogs walk ‘barefoot’ and get all sorts of contaminants depending on what (or where) they stepped in. 

In such cases, secondary complications are basically expected, even if no immediate signs are visible on the initial inspection.

Common Secondary Complications That Develop Over Time

The first few days after the injury, it’s all about the swelling and the bruises. Once that dies down, the patient can make the mistake of thinking that the worst is over, when real problems are just starting to form. These are secondary complications, and it can even be months until they show up. 

One common delayed problem is nerve trouble. There are many nerves around the eye that control all of its movements, and after an injury, a swelling or a small bone shift can press on those nerves. The patient mightn’t notice it right away.

Then, weeks could pass, and they might feel a numb spot on their cheek or forehead or find that they can’t blink properly, feel a weird pain that doesn’t go away, etc. Nerve damage is mostly a slow reveal.

Infection can also be late to the party. 

A small cut can heal perfectly fine on the surface, but that doesn’t mean that germs didn’t get inside and start growing in a deeper wound or a tiny crack in the bone. But perhaps the most problematic and the most urgent delayed issue is the build-up of pressure. 

Bleeding and swelling can still be going on inside the eye socket after the injury has seemingly healed. This increases pressure, which squeezes the optic nerve and blood vessels. Sudden vision loss, extreme pain, and eye bulging forward are all symptoms of this condition. 

This is a serious medical emergency, and it’s vital to get medical attention immediately in order to protect vision. 

Conclusion

As it turns out, the story of an eye injury could be hiding a major plot twist.

A black eye, a cut, or what have you is still the main event, but the real drama can start after the patient has pretty much forgotten they had an injury. 

Panic is never the right answer – neither for the patient nor for the doctor, which is why the best course of action is always to schedule a follow-up and let the patient know that secondary complications exist. 

If they know exactly when they need to pick up a phone and call, the story has a much better shot at a happy ending.