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Ophthalmology and Visual Sciences

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Periorbital Emphysema Following Ocular Trauma

Contributors: Pavane L. Gorrepati, BA; Aaron M. Ricca, MD; Audrey C. Ko, MD

Photographer: Audrey C. Ko, MD

Posted July 31, 2018

A 25-year-old man presented to the University of Iowa Hospitals and Clinics with an asymptomatic right medial orbital wall fracture without signs of entrapment or retrobulbar hemorrhage.  Examination was remarkable for crepitus when palpating the inferior orbital rim. In patients with a history of facial trauma, surgery, or sinusitis, air can travel through the damaged sinus and become trapped in the subcutaneous tissues in and/or surrounding the orbit.  It is typically a self-limiting condition with spontaneous recovery in two to three weeks [1]. However, if a large amount of air becomes entrapped within the orbit, vision loss can occur secondary to optic nerve compression leading to ischemic optic neuropathy. Drainage of the trapped air in the subcutaneous tissue may be considered if there are signs of orbital compartment syndrome threatening vision [2].

External photographs in frontal view (A) and worm's eye view (B) showing fullness in the area correlating with crepitus on examination (asterisks).

Figure 1. External photographs in frontal view (A) and worm's eye view (B) showing fullness in the area correlating with crepitus on examination (asterisks).

Coronal (A) and axial (B) computed tomography images of the head show the presence of subcutaneous air (asterisks).

Figure 2. Coronal (A) and axial (B) computed tomography images of the head show the presence of subcutaneous air (asterisks).

References

  1. Moon H, Kim Y, Wi JM, Chi M. Morphological characteristics and clinical manifestations of orbital emphysema caused by isolated medial orbital wall fractures. Eye (Lond) 2016;30(4):582-587.  https://PubMed.gov/26795415. DOI: 10.1038/eye.2015.285
  2. Shah N. Spontaneous subcutaneous orbital emphysema following forceful nose blowing: treatment options. Indian J Ophthalmol 2007;55(5):395.  https://PubMed.gov/17699958

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last updated: 07/31/2018
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