Clinical introduction

A 65-year-old woman presented with head and facial trauma after a fall from standing height. Her vital signs were normal, and physical examination revealed right-sided facial contusions and bilateral periorbital ecchymoses (ie, a raccoon sign or panda eyes) (figure 1). She denied a headache and orbital pain. Head computed tomography (CT) was performed, but no skull fracture, periorbital haematoma, encephalorrhagia, punched-out lesion or tumour was detected. Laboratory data indicated kidney dysfunction. The patient reported that the non-painful periorbital skin lesion developed over a period of 1–2 years.