What should you know about neuroblastoma raccoon eyes?

The term describes dark bruising or purplish swelling around both eyes. In neuroblastoma, disease can affect bones or soft tissues around the eye and alter the appearance of the eyelids. The finding is concerning but is not a diagnosis by itself; bruising, injury, infection and other medical conditions can look similar. A clinician should assess the child, review other symptoms and arrange appropriate tests when needed.

Arrange prompt medical assessment, especially if the change appeared without a clear injury or is accompanied by a lump, bone pain, tiredness, weight change, fever or unusual weakness. Do not press or massage a swollen area. Photographing the appearance for comparison may help the clinician, but it should not delay care. If neuroblastoma is diagnosed, treatment may involve [Chemotherapy](/treatments/systemic-therapy/chemotherapy/), [Tumour Removal Surgery](/treatments/surgical-oncology/tumour-removal-surgery/), or [Targeted Radioisotope Therapy](/treatments/radiation-oncology/targeted-radioisotope-therapy/).

Seek emergency care for vision loss, severe eye pain, rapidly increasing swelling, unequal pupils, difficulty breathing, collapse, seizure, or a child who is hard to wake. Contact a clinician promptly for unexplained bruising around the eyes, persistent headache, vomiting, fever or new weakness. Urgency is based on the child’s symptoms and examination, not on the appearance alone.

Could this be bruising, infection, injury or a tumour-related change? Does the child need eye, neurological or imaging assessment? Which symptoms should prompt emergency care? What should we avoid putting on the skin? If tests find neuroblastoma, what is the next decision point?