Raccoon Sign

The 'Raccoon sign' comprises unilateral or bilateral progressive periorbital ecchymosis associated with edema. It is also referred to as the 'raccoon eyes' and the 'panda sign.' The pooling of blood around the eyes is most commonly associated with fractures of the base of the anterior cranial fossa. This finding is not observed immediately following the injury and is typically delayed by 1 to 3 days. If it presents bilaterally, this finding is highly predictive of an anterior skull base fracture. Classically, the tarsal plate will be spared in this condition. Further extravasation of the blood beyond the periorbital region is limited owing to the orbital septum inserted into the tarsal plate.