For orbital emphysema, emergent decompression is necessary if there is any suspicion of orbital compartment syndrome otherwise, it will resolve on its own as air is absorbed. The management of orbital fractures with orbital emphysema depends largely on the clinical presentation. 4 Complications of orbital emphysema can include proptosis, loss of vision, increased intraocular pressure, and decreased eye movement. This usually is caused by trauma, and the presence of orbital emphysema in the absence of an apparent fracture suggests an occult fracture of the orbit. 6 Furthermore, orbital emphysema can occur after forceful injection of air into orbital soft tissue spaces, as was seen in our case after a sneeze. 4,5 One study of 76 patients showed that the incidence of eye movement limitation in medial wall fractures was 12.5% and diplopia was 25%. With any nasoethmoid or lamina papyracea fractures, the medial rectus muscle may be come incarcerated, which can lead to restriction of horizontal mobility of the affected eye. Isolated medial wall fractures occur in 10% to 30% of cases of orbital trauma. Orbital CT imaging should be considered to localize the fracture and identify any associated injuries. The CT images showed right-sided postseptal soft-tissue gas (emphysema) related to the acute fracture of the right lamina papyracea, without muscle entrapment ( C and D).Ĭlinicians should maintain a high index of suspicion for orbital wall fractures in patients in whom there is any indication of high-force trauma to the eye, crepitus or step-off, vision changes, or signs of muscle entrapment. The rest of the examination findings were normal.īecause of a clinical concern for an orbital fracture with extraocular muscle entrapment, an orbital computed tomography (CT) scan without contrast was performed. His pupils were equal, round, and reactive to light, and his vision was 20/20 bilaterally. No proptosis, enophthalmos, or subconjunctival hemorrhage was present. There was pain to palpation over the medial right border of the nasal bridge, but no crepitus or palpable bony step-off. Extraocular muscles were intact, except for minimal asymmetry on upward gaze, with the patient reporting a subjective upward gaze limitation ( B).Ĭould Aspirin Slow Progression of Emphysema? Upon presentation to the ED, infraorbital swelling was obvious, with erythema and a linear bruising pattern at the infraorbital rim ( A). The patient had no significant medical history and did not wear glasses or contact lenses. He denied headache, vomiting, recent illness, or fever. He complained of mild pain to the right eye and a subjective feeling of limited upward gaze, but he reported no changes in vision. Earlier on the day of presentation, he had sneezed and had experienced immediate pain and significant swelling to the lower eyelid. He had been elbowed in the eye 3 days prior but had noted only minimal swelling at the time. A previously healthy 11-year-old boy presented to the emergency department with acute right eye pain and swelling.
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